The preoperative hemoglobin, albumin, lymphocyte, and platelet score is a prognostic factor for non-small cell lung cancer patients undergoing adjuvant chemotherapy: a retrospective study

Abstract

Background: Developing a simple, reliable and low-cost biomarkers is crucial to predict the prognosis of non-small cell lung cancer (NSCLC) patients receiving adjuvant chemotherapy. The score combining hemoglobin and albumin levels and lymphocyte and platelet counts (HALP score) is reportedly related to the prognosis of multiple types of tumors. However, few studies have focused on its prognostic value in patients with NSCLC. Our study aimed to investigate the prognostic role of the HALP score and develop a valuable prognostic model for patients with NSCLC undergoing adjuvant chemotherapy.Methods: A total of 362 individuals with NSCLC undergoing adjuvant chemotherapy between 2013 and 2015 were included. The HALP score was computed according to the following formula: hemoglobin (g/L) × albumin (g/L) × lymphocytes (g/L)/platelets (g/L). Furthermore, demographic characteristic, including age, sex, smoking status, and drinking history, were collected from case report forms at admission. The main outcomes were overall survival (OS) and disease-free survival (DFS), which were assessed using Kaplan-Meier analysis with log-rank test. Furthermore, Cox regression analysis was employed to assess the prognostic role of HALP in NSCLC.Results: We found the significant associations of clinicopathological features, including sex, pathological stage, tumor size, and lymph node metastasis (LNMets) in univariate Cox regression analysis. In multivariate analysis, NSCLC patients with a high HALP score were significantly associated with lower OS [hazard ratio (HR): 0.707; 95% confidence interval (CI): 0.503-0.995] and DFS (HR: 0.671; 95% CI: 0.491-0.916). The Kaplan-Meier analysis showed that a low HALP score predicted poorer OS (P=0.02) and DFS (P<0.01) outcomes. Furthermore, we performed stratification analysis by tumor node metastasis (TNM) stage, and the result indicated a low HALP score predicted poor OS (P=0.01) and DFS (P=0.04) outcomes in stage III-IV NSCLC patients. Conclusions: Our study demonstrated that the HALP score might be a suitable prognostic index for NSCLC patients undergoing adjuvant chemotherapy. Combining demographic and clinicopathological features with the HALP score may help clinicians predict survival and treatment outcomes. Keywords: Non-small cell lung cancer (NSCLC); score combining hemoglobin and albumin levels and lymphocyte and platelet counts (HALP score); overall survival (OS); disease-free survival (DFS)

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

“…Interestingly, this paper found that if stratified by tumor type, low HALP was predictive of worse overall survival for lung adenocarcinoma on Kaplan Meier analysis (p < 0.001) but lost significance when stratifying for nonadenocarcinoma disease (p = 0.194). Most recently in 2022, Wei et al, showed HALP to be retrospectively predictive in 362 patients with nonsmall cell lung cancer undergoing adjuvant chemotherapy [75]. Kaplan Meier analysis showed that HALP <48.2, calculated by X-tile, predicted worse overall survival (p = 0.02) and worse disease-free survival (p < 0.01).…”

“…Most recently in 2022, Wei et al, showed HALP to be retrospectively predictive in 362 patients with non-small cell lung cancer undergoing adjuvant chemotherapy [ 75 ]. Kaplan Meier analysis showed that HALP <48.2, calculated by X-tile, predicted worse overall survival ( p = 0.02) and worse disease-free survival ( p < 0.01).…”

Prognostic value of inflammatory and nutritional indexes among advanced NSCLC patients receiving PD‐1 inhibitor therapy

“…As a sign of malnutrition, low levels of albumin and haemoglobin were associated with unfavourable clinical outcomes, but they were not predictors for disease control 34–37 . The HALP score has been shown to be a prognostic indicator 38,39 for NSCLC patients who have undergone surgery 14 and adjuvant chemotherapy 40 . However, there are no recent studies looking into the relationship of the HALP score with prognoses of NSCLC patients treated with immunotherapy.…”

“… 34 , 35 , 36 , 37 The HALP score has been shown to be a prognostic indicator 38 , 39 for NSCLC patients who have undergone surgery 14 and adjuvant chemotherapy. 40 However, there are no recent studies looking into the relationship of the HALP score with prognoses of NSCLC patients treated with immunotherapy. In this study, we did not find the association between HALP and patient survival.…”

“…ECOG, Eastern Cooperative Oncology Group; NLR, neutrophil-tolymphocyte ratio; PNI, prognostic nutritional index been shown to be a prognostic indicator 38,39 for NSCLC patients who have undergone surgery 14 and adjuvant chemotherapy. 40 However, there are no recent studies looking into the relationship of the HALP score with prognoses of NSCLC patients treated with immunotherapy.…”