The hemoglobin, albumin, lymphocyte, and platelet score is a prognostic factor for Child-PughA patients undergoing curative hepatic resection for single and small hepatocellular carcinoma.

Abstract

The hemoglobin, albumin, lymphocyte, and platelet (HALP) score reflects the immune system and the nutritional status of patients, and prognosis in various cancers. However, the HALP score in hepatocellular carcinoma has not been reported. Data were analyzed retrospectively from Child-PughA patients undergoing hepatic resection for single hepatocellular carcinoma ≤5cm. For cross-validation, patients were divided into the training (332 patients) and validation cohort (210 patients). In the training cohort, we divided patients into two groups by appropriate cut-off value of the HALP score, and univariable and multivariable analyses were conducted for disease-free and overall survival (OS) between two groups. In the validation cohort, we examined OS by Kaplan-Meier analysis in the same cut-off value of the HALP score in the training cohort. The HALP-low group was significantly older (p=0.0003), had fewer hepatitisB surface antigen-positive patients (p=0.0369), higher prothrombin time (p=0.0141), lower fibrosis-4 index (p=0.0206), bigger maximum tumor size (p=0.0196), and less histological liver fibrosis (p=0.0077). Multivariate analysis showed that the independent prognostic factors for disease-free survival were fibrosis-4 index ≥2.67 (p=0.0008), simple nodular type with extranodular growth or confluent multinodular type (p=0.0221), and intrahepatic metastasis (p=0.0233), and that for OS were fibrosis-4 index ≥2.67 (p=0.0020), HALP ≤45.6 (p=0.0228), and poor differentiation (p=0.0305). In the validation cohort, Kaplan-Meier analysis revealed the trend toward significantly impaired OS (p=0.0220) in the HALP-low group. We showed that a low HALP score is the independent prognostic factor for Child-PughA patients undergoing curative hepatic resection for single and small hepatocellular carcinoma.