Beyond Simple Ratios: Can the Preoperative HALP Score Provide a More Effective Inflammatory Biomarker for Colon Cancer Survival?

Background and

Objectives

Previous findings have suggested that inflammatory and nutritional biomarkers may help predict the prognosis in colorectal cancer patients; however, their predictive value and optimal use remain uncertain. Therefore, this study aimed to investigate the effects of several preoperatively measured inflammatory and nutritional biomarkers on the overall survival in patients undergoing surgery for colon cancer and to compare their predictive ability between themselves and with other clinical parameters. Materials and

Methods

This retrospective cohort study included 411 patients who underwent surgery for colon cancer between May 2014 and May 2024. Demographic, clinical, pathological, and laboratory data were analyzed. The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), De Ritis ratio, Gustave Roussy Immune (GRIM) score, and hemoglobin, albumin, lymphocyte, and platelet (HALP) score were calculated from preoperative laboratory values. Cox regression, receiver operating characteristic (ROC), and Kaplan-Meier survival analyses were performed.

Results

During follow-up, 270 patients (65.7%) survived, and 141 (34.3%) died. The survival group was significantly younger than the mortality group (p < 0.001). The hemoglobin level and HALP score were significantly higher in the survival group, whereas the PLR was significantly higher in the mortality group. In the multivariate analysis, adjusted for baseline clinical and pathological factors, the age (HR: 1.046, 95% CI: 1.030-1.062, p < 0.001) and the HALP score (HR: 0.984, 95% CI: 0.971-0.998, p = 0.025) were identified as independent predictors of mortality. A HALP score cut-off value of 38.8 predicted mortality with 85.1% sensitivity and 31.9% specificity (AUC: 0.597, p = 0.001). Patients with HALP scores > 38.8 had significantly longer overall survival (p < 0.001).

Conclusions

The preoperative HALP score is an independent predictor of overall survival in patients with colon cancer. As a simple and readily available immune-nutritional biomarker, the HALP score may contribute to preoperative risk stratification and prognostic assessment in routine clinical practice, serving as a supplementary tool alongside traditional staging.