A HALP score-based prediction model for survival of patients with the upper tract urothelial carcinoma undergoing radical nephroureterectomy

Xiaomin Gao, Binwei Lin, Qi Lin, Tingyu Ye, Tao Zhou, Maolin Hu, Honghui Zhu, Feng Lu, Wei Chen, Peng Xia, Fangyi Zhang, Zhixian Yu, Xiaomin Gao, Binwei Lin, Qi Lin, Tingyu Ye, Tao Zhou, Maolin Hu, Honghui Zhu, Feng Lu, Wei Chen, Peng Xia, Fangyi Zhang, Zhixian Yu

Abstract

The combination of hemoglobin, albumin, lymphocyte, and platelet (HALP) score has been confirmed as an important risk biomarker in several cancers. Hence, we aimed at evaluating the prognostic value of the HALP score in patients with non-metastatic upper tract urothelial carcinoma (UTUC). We retrospectively enrolled 533 of the 640 patients from two centers (315 and 325 patients, respectively) who underwent radical nephroureterectomy (RNU) for UTUC in this study. The cutoff value of HALP was determined using the Youden index by performing receiver operating characteristic (ROC) curve analysis. The relationship between postoperative survival outcomes and preoperative HALP level was assessed using Kaplan-Meier analysis and Cox regression analysis. As a result, the cutoff value of HALP was 28.67 and patients were then divided into HALP<28.67 group and HALP≥28.67 group. Kaplan-Meier analysis and log-rank test revealed that HALP was significantly associated with overall survival (OS) (P<0.001) and progression-free survival (PFS) (P<0.001). Multivariate analysis demonstrated that lower HALP score was an independent risk factor for OS (HR=1.54, 95%CI, 1.14-2.01, P=0.006) and PFS (HR=1.44, 95%CI, 1.07-1.93, P=0.020). Nomograms of OS and PFS incorporated with HALP score were more accurate in predicting prognosis than without. In the subgroup analysis, the HALP score could also stratify patients with respect to survival under different pathologic T stages. Therefore, pretreatment HALP score was an independent prognostic factor of OS and PFS in UTUC patients undergoing RNU.

Conflict of interest statement

Conflicts of interest: The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
The patient selection flowchart (A) and histogram of HALP (B). HALP: Hemoglobin, albumin, lymphocyte, and platelet.
FIGURE 2
FIGURE 2
Kaplan–Meier analysis for OS (A-D) and PFS (E-H) in UTUC patients according to HALP, hemoglobin, albumin, and PLR. OS: Overall survival; PFS: Progression-free survival; HALP: Hemoglobin, albumin, lymphocyte, and platelet.
FIGURE 3
FIGURE 3
Established nomograms (A) for OS in patients with UTUC and calibration curve for predicting 3- and 5-year; (B, C) survival of OS. To use the nomogram, an individual UTUC patients’ value is located on each variable axis, and a line is depicted upward to determine the number of points received for each variable value. Subsequently, the sum of these numbers is located on Total Point axis, and a line is drawn downward to the survival axes to determine the likelihood of 3- and 5-year survival. OS: Overall survival; UTUC: Upper tract urothelial carcinoma.
FIGURE 4
FIGURE 4
Established nomograms (A) for PFS in patients with UTUC and calibration curve for predicting 3- and 5-year; (B, C) survival of PFS. UTUC: Upper tract urothelial carcinoma; PFS: Progression-free survival.
FIGURE 5
FIGURE 5
ROC analysis of the prognostic accuracy of HALP for OS and PFS in established models. ROC: Receiver operating characteristic; HALP: Hemoglobin, albumin, lymphocyte and platelet; OS: Overall survival; PFS: Progression-free survival.
FIGURE 6
FIGURE 6
Subgroup analysis to evaluate the prognostic ability of HALP in predicting OS (A-D) and PFS (E-H) in UTUC patients under pathologic T stage. HALP: Hemoglobin, albumin, lymphocyte, and platelet; OS: Overall survival; PFS: Progression-free survival.
SUPPLEMENTARY FIGURE 1
SUPPLEMENTARY FIGURE 1
Determination of the optimal cutoff value for HALP based on the ROC analysis. HALP: Hemoglobin, albumin, lymphocyte, and platelet; ROC: Receiver operating characteristic
SUPPLEMENTARY FIGURE 2
SUPPLEMENTARY FIGURE 2
Determination of the optimal cutoff value for PLR based on the ROC analysis. ROC: Receiver operating characteristic; PLR: Platelet-to-lymphocyte ratio

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