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The Association Between the Hemoglobin-Albumin-Lymphocyte-Platelet (HALP) Score and Lymph Node Metastasis in Early
Oğuz Kaan Köksal1, Şahin Kaan Baydemir1, Hande Nur Öncü1
1Department of Gynecologic Oncology, Etlik City Hospital, Ankara, Turkey.
Objective:
To investigate the association between hemoglobin-albumin-lymphocyte-platelet (HALP) score and lymph node metastasis (LNM) in patients with early and locally advanced cervical cancer.
Methods:
This retrospective observational cohort study included patients with FIGO 2018 stage IA-IIIC cervical cancer treated at a tertiary gynecologic oncology center between November 2022 and January 2025. Lymph node status was determined by pathological and/or radiological evaluation. HALP score was calculated using pretreatment hemoglobin, albumin, lymphocyte, and platelet values. Receiver operating characteristic (ROC) analysis was performed to determine the optimal HALP cutoff value to predict LNM. Univariate and multivariate logistic regression analyses were conducted to identify factors associated with LNM, adjusting for established clinicopathological variables.
Results:
A total of 136 patients were included. Patients with LNM had significantly lower HALP scores than those without LNM (median 29.8 vs. 42.8, p = 0.001). ROC analysis demonstrated a moderate discriminative ability of HALP for predicting LNM (AUC 0.697, 95% CI 0.610-0.785), with an optimal cutoff value of 22.4. Sensitivity analysis in surgically staged patients (n = 83) yielded consistent results (AUC 0.692; p = 0.006). In univariate analysis, HALP ≤ 22.4, tumor size > 2 cm, lymphovascular space invasion (LVSI), and parametrial involvement were significantly associated with LNM. In multivariate analysis, HALP ≤ 22.4 and LVSI remained independent predictors of LNM.
Conclusion:
The HALP score is a simple, inexpensive, and readily available immunonutrition index that may serve as an adjunctive biomarker for pretreatment risk stratification of LNM in patients with early and locally advanced cervical cancer. Prospective multicenter studies are warranted to confirm these findings.
