Hemoglobin-Albumin-Lymphocyte-Platelet Score as an Integrative Biomarker for Prognosis and Sarcopenia in Colorectal Cancer

Hailun Xie,1,2,* Lishuang Wei,3,* Shuangyi Tang,4 Jialiang Gan2,5 1Department of Gastrointestinal and Gland Surgery, the First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, People’s Republic of China; 2Guangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, Nanning, Guangxi, People’s Republic of China; 3Department of Geriatric Respiratory Disease Ward, the First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, People’s Republic of China; 4Department of Pharmacy, the First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, People’s Republic of China; 5Department of Colorectal and Anal Surgery, the First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, People’s Republic of China*These authors contributed equally to this workCorrespondence: Shuangyi Tang, Department of Pharmacy, the First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, Guangxi, 530021, People’s Republic of China, Email [email protected] Jialiang Gan, Department of Colorectal and Anal Surgery, the First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, Guangxi, 530021, People’s Republic of China, Tel +86-13878155172, Email [email protected]: This study aimed to comprehensively investigate the dose-response relationship between the Hemoglobin-Albumin-Lymphocyte-Platelet (HALP) score, which reflects the combined inflammatory and nutritional status, and progression-free survival (PFS), overall survival (OS), as well as sarcopenia in patients with colorectal cancer (CRC).Methods: A retrospective analysis was conducted on 1,441 CRC patients who underwent surgery. HALP score was calculated as Hemoglobin (g/L) × Albumin (g/L) × Lymphocyte count (109/L) / Platelet count (109/L). Survival analysis was carried out using Kaplan - Meier curves and Cox regression analysis. Logistic regression analysis was employed to analyze the relationship between the HALP and sarcopenia. HALP - based nomograms were developed to predict 1 - and 5 - year PFS and OS.Results: Kaplan - Meier analysis showed that patients with low HALP scores had worse PFS (51.2% vs 63.3%, p < 0.001) and OS (54.1% vs 66.0%, p < 0.001). For every standard deviation increase in HALP scores, the HR for PFS decreased by 13.3% (HR = 0.867, 95% CI = 0.780– 0.963, p = 0.008), and for OS by 15.2% (HR = 0.848, 95% CI = 0.759– 0.948, p = 0.004). Multivariate Cox regression analysis confirmed HALP as an independent prognostic factor for PFS and OS. Logistic regression analysis indicated that low HALP scores were an independent predictor of sarcopenia (OR = 0.550, 95% CI = 0.420– 0.963, p < 0.001). The HALP-based nomograms demonstrated strong predictive performance for prognosis, with C-indexes of 0.726 (PFS) and 0.728 (OS) and 5-year AUCs exceeding 0.76.Conclusion: Low HALP scores are independent risk factors for PFS, OS, and sarcopenia in CRC patients, highlighting HALP’s potential for clinical application in CRC management and may thus assist in personalized treatment decisions.Keywords: colorectal cancer, HALP score, progression-free survival, overall survival, sarcopenia