Hemoglobin, albumin, lymphocyte, and platelet (HALP) score as a prognostic indicator in patients with bladder cancer undergoing radical cystectomy.

Abstract

852 Background: Prognosis in cancer patients is a combination of tumor characteristics and immunobiology. While a variety of hemogram parameters have been examined, HALP scores have demonstrated some of the most significant prognostic value across multiple cancers. In this study, we examine the prognostic value of HALP scores in patients with bladder cancer (BCa) undergoing radical cystectomy (RC). Methods: Using our prospective, IRB-approved cystectomy database, we identified patients who underwent RC between 2007 and 2024. Patients with incomplete CBC and CMP data were excluded. Patients were stratified into four quartiles (Q1-Q4, Q1 as reference). Associations of HALP scores with overall survival (OS) and recurrence-free survival (RFS) were assessed with multivariate Cox regression models. Results: The cohort included 1,098 patients who had CBC and CMP data within 60 days prior to RC, and HALP scores were calculated using the formula Hb×Alb×(#AbsLymph÷Pt) (demographics in Table 1). Of note, patients in HALP Q1 and Q2 had significantly more 30- and 90-day complications (p=0.02, p=0.01) and had more severe 90-day complications (p=0.02) compared to higher HALP quartiles (Clavien-Dindo classification). Patients in HALP Q3 and Q4 had improved OS (HR=0.575, p=0.0004; HR=0.673, p=0.01) as compared to Q1 quartile. Additionally, patients in HALP Q3 had improved RFS (HR=0.648, p=0.01). Conclusions: HALP scores are a significant marker for predicting postoperative complications and OSl in patients undergoing RC for BCa. HALP scores could be used for further risk stratification and for optimizing overall fitness before surgery. Demographic distribution of HALP cohort. Characteristics Q1 (N=274) Q2 (N=274) Q3 (N=275) Q4 (N=275) p-value Age, n (%) ≤65 yrs. >65 yrs. 73 (26.6)201 (73.4) 79 (28.8)95 (71.2) 82 (29.8)193 (70.2) 106 (38.5)169 (61.5) 0.01 Sex, n (%) M F 203 (74.1)71 (25.9) 214 (78.1)60 (21.9) 237 (86.2)38 (13.8) 243 (88.4)32 (11.6) <0.001 Charleson Comorbidity Index, n (%) 0 1 ≥2 48 (17.5)61 (22.3)165 (60.2) 59 (21.5)78 (28.5)137 (50.0) 62 (22.5)86 (31.3)127 (46.2) 60 (21.8)63 (22.9)152 (55.3) 0.03 Neoadjuvant chemotherapy, n (%) Y N 112 (40.9)162 (59.1) 114 (41.6)160 (58.4) 192 (69.8)83 (30.2) 68 (24.7)207 (75.3) <0.001 Pathological staging, n (%) Organ confined (< (y)pT2N0) Extravesical (> (y)pT2N0) Lymph node positive (pN+) 138 (50.4)51 (18.6)85 (31.0) 174 (63.5)40 (14.6)60 (21.9) 172 (62.5)43 (15.6)60 (21.8) 204 (74.2)34 (12.4)37 (13.5) <0.001 Complications, n (%) 30-day Y N 90-day Y N 181 (66.1)93 (33.9)7216 (8.8)58 (21.2) 160 (58.4)114 (41.8)193 (70.4)81 (29.6) 160 (58.2)115 (41.8)191 (69.5)84 (30.5) 146 (53.1)129 (46.9)180 (65.5)95 (34.5) 0.02 0.01 Severity of 90-day complications, n (%) None I-II III-V 67 (24.5)149 (54.4)58 (21.2) 90 (32.8)123 (44.9)61 (22.3) 93 (33.8)140 (50.9)42 (15.3) 99 (36.0)133 (48.4)43 (15.6) 0.02