Impact of pre-treatment prognostic nutritional index and the haemoglobin, albumin, lymphocyte and platelet (HALP) score on endometrial cancer survival: A prospective database analysis

Abstract

Purpose The Onodera’s prognostic nutritional index (PNI) and the haemoglobin, albumin, lymphocyte and platelet (HALP) score are immune-nutritional indices that correlate with survival outcomes in several adult solid malignancies. The aim of this study was to investigate whether PNI and HALP are associated with survival outcomes in endometrial cancer. Patients and methods Women undergoing management for endometrial cancer were recruited to a single centre prospective cohort study. Pre-treatment PNI and HALP scores were computed for study participants and analysed as continuous variables and by selecting cut-off values based on previous publications. Both parameters were analysed in relation to overall, endometrial cancer-specific and recurrence-free survival using Kaplan-Meier estimation and multivariable Cox proportional regression. Results A total of 439 women, with a median age of 67 years (interquartile range (IQR), 58, 74) and BMI of 31kg/m2 (IQR 26, 37) were included in the analysis. Most had low-grade (63.3%), early-stage (84.4% stage I/II) endometrial cancer of endometrioid histological subtype (72.7%). Primary treatment was surgery in 98.2% of cases. Adjusted overall mortality hazard ratios for PNI and HALP as continuous variables were 0.97(95%CI 0.94–1.00, p = 0.136) and 0.99(95%CI 0.98–1.01, p = 0.368), respectively. Women with pre-treatment PNI ≥45 had a 45% decrease in both overall (adjusted HR = 0.55, 95% CI 0.33–0.92, p = 0.022) and cancer-specific mortality risk (adjusted HR = 0.55, 95%CI 0.30–0.99, p = 0.048) compared to those with PNI <45. There was no evidence for an effect of PNI on recurrence free survival. HALP scores were associated with adverse clinico-pathologic factors, but not overall, cancer-specific or recurrence-free survival in the multivariable analysis. Conclusion PNI is an independent prognostic factor in endometrial cancer and has the potential to refine pre-operative risk assessment.

What is hemoglobin, albumin, lymphocyte, platelet (HALP) score? A comprehensive literature review of HALP’s prognostic ability in different cancer types

“…It is worth noting that several papers only looked at patients of single sex. For example, papers on breast, endometrial, and cervical cancer only considered female patients, while papers on prostate cancer and one paper on esophageal cancer exclusively male populations [48,[61][62][63][64][65][66]. Two papers on pharyngeal cancer had primarily male populations [49,67].…”

“…Furthermore, HALP scores have been used in endometrial cancer patients. In a prospective study by Njoku et al, on 439 endometrial cancer patients, HALP was specifically associated with FIGO staging, histology, disease grade, LVSI, and deep myometrial invasion [ 63 ]. However, HALP scores were not shown to be associated with overall, cancer-specific or recurrence-free survival, which this study concluded could be due to unaccounted confounders affecting HALP.…”

“…In cervical cancer, Leetanaporn et al, found lower HALP predicted higher tumor stage and larger tumor size [ 48 ]. Njoku et al, found low HALP was associated with worse FIGO stage and worse differentiation in endometrial cancer [ 63 ]. Peng et al, showed that creating a nomogram with HALP better predicted radical cystectomy and radical nephrectomy outcomes than traditional TNM Staging [ 42 , 43 ].…”

Nomogram for Predicting Overall Survival of Metastatic Pancreatic Cancer Patients based on Inflammatory- Nutritional Biomarkers and HBV Infection

“…(16) Several in ammatory biomarkers and nutritional indicators, such as the neutrophil-albumin ratio (NAR) and the combined index of hemoglobin, albumin, lymphocyte, and platelet(HALP), correlate with prognosis in many cancers. (2,(17)(18)(19) However, the pred ictive usefulness of these biomarkers for mPC is unknown.…”

Prognostic impact of the hemoglobin–albumin–lymphocyte–platelet score in patients with oral cavity cancer undergoing surgery

“…8,9 The nutrition parameters, such as serum albumin and hemoglobin levels, and inflammation parameters, such as lymphocyte and platelet counts, have been reported to have substantial roles in OSCC prognostication. [10][11][12] Recently, the hemoglobin-albumin-lymphocyte-platelet (HALP) score integrates the aforementioned parameters and has been demonstrated to be a prognostic biomarker in cancers of the pancreas, 13 bladder, 14 prostate, 15 endometrium, 16 breast, 17 and cervix. 18 Thus, the adoption of a relatively high-accuracy and convenient preoperative laboratory index in prognostic stratifications of OSCC might contribute to a better prognosis with optimal adjuvant therapies.…”