HALP outperforms systemic inflammatory biomarkers for prognosis in locally advanced cervical cancer treated with...

Patients with locally advanced cervical cancer (LACC) treated with concurrent chemoradiotherapy (CCRT) show substantial heterogeneity in survival outcomes, whereas the comparative prognostic value of systemic inflammatory and nutritional biomarkers remains unclear. This study aimed to compare pretreatment inflammatory biomarkers, identify the most informative prognostic indicator, and develop a practical risk-stratification model for LACC. In this multicenter retrospective study, 290 patients with International Federation of Gynecology and Obstetrics (FIGO) stage IIB-IIIC cervical squamous cell carcinoma treated with definitive platinum-based CCRT followed by brachytherapy at two tertiary centers were analyzed. Twelve pretreatment inflammatory and nutritional indices, including the hemoglobin-albumin-lymphocyte-platelet (HALP) score, pan-immune-inflammation value (PIV), and neutrophil-to-lymphocyte ratio (NLR), were evaluated for overall survival (OS) and progression-free survival (PFS) using the concordance index (C-index), time-dependent area under the curve (AUC), and Brier score. Cox regression identified independent prognostic factors, and HALP-based nomograms were internally validated. Among all biomarkers, HALP showed the best and most stable prognostic performance for both OS and PFS, with the highest discrimination and lowest prediction error. Low HALP remained independently associated with worse OS and PFS in multivariable analysis (OS: hazard ratio [HR], 1.654; 95% confidence interval [CI], 1.165-2.366; PFS: HR, 1.702; 95% CI, 1.233-2.344). Nomograms integrating HALP, tumor size, and human papillomavirus (HPV) status showed good calibration and improved predictive accuracy beyond FIGO stage and the baseline clinical model. HALP may therefore serve as a robust, inexpensive, and clinically accessible biomarker for individualized risk stratification in LACC.