The preoperative hemoglobin, albumin, lymphocyte, and platelet score as a prognostic Indicator for survival in gastric and colorectal cancer patients
TL;DR
Low preoperative HALP independently predicted poor prognosis in gastric and colorectal cancers during follow-up, particularly in Stage III disease, supporting its use as a complementary marker reflecting the synergistic cascade of malnutrition, inflammation, and immunosuppression linked to tumor aggressiveness.
Abstract
Background Gastric and colorectal cancers have high postoperative recurrence despite curative surgery. Current preoperative nutritional assessments often do not fully integrate immune integration and objectivity. The primary objective was to explore preoperative HALP—a composite metric of hemoglobin, albumin, lymphocyte, and platelet values—and postoperative prognosis within the observed follow-up period in gastric and colorectal cancer. Methods This prospective cohort study enrolled patients with gastric or colorectal cancer (aged ≥18 years, stage I-III, without neoadjuvant therapy) between May 2021 and June 2022. Preoperative laboratory data within 24 h of admission were collected, and HALP scores were calculated and dichotomized into low and high groups using the established cutoff of 16.81. Patients underwent quarterly postoperative follow-up until May 2025, with overall survival (OS) and progression-free survival (PFS) as endpoints, and statistical analyses included Kaplan–Meier survival curves and Cox regression models. Results The study cohort (median age 65 years; 66.8% male) included 75 gastric cancer patients (40.1%) and 112 colorectal cancer patients (59.9%), with 31 patients (16.6%) categorized in the low-HALP group. In both gastric and colorectal cancers, low-HALP patients had significantly inferior OS (log-rank p = 0.0056 and 0.0117, respectively), with a non-significant trend toward worse PFS in both subgroups. Multivariable Cox regression confirmed HALP as an independent predictor of OS/PFS (OS HR = 0.138, p = 0.000; PFS HR = 0.415, p = 0.009) in gastric and colorectal cancers. Critically, after TNM stage adjustment, Low-HALP remained associated with worse survival specifically in Stage III patients (both log-rank p < 0.05). Conclusion Low preoperative HALP independently predicted poor prognosis in gastric and colorectal cancers during follow-up, particularly in Stage III disease, supporting its use as a complementary marker reflecting the synergistic cascade of malnutrition, inflammation, and immunosuppression linked to tumor aggressiveness.