Department of Gastrointestinal Surgery, Sichuan University West China Hospital, Chengdu 610041, Sichuan Province, China.
World J Gastroenterol. 2022 Jul 21;28(27):3476-3487. doi: 10.3748/wjg.v28.i27.3476.
The combined index of hemoglobin, albumin, lymphocyte, and platelet (HALP) can reflect systemic inflammation and nutritional status simultaneously, with some evidence revealing its prognostic value for some tumors. However, the effect of HALP on recurrence-free survival (RFS) in patients with gastrointestinal stromal tumors (GISTs) has not been reported.
To investigate the prognostic value of HALP in GIST patients.
Data from 591 untreated patients who underwent R0 resection for primary and localized GISTs at West China Hospital between December 2008 and December 2016 were included. Clinicopathological data, preoperative albumin, blood routine information, postoperative treatment, and recurrence status were recorded. To eliminate baseline inequivalence, the propensity scores matching (PSM) method was introduced. Ultimately, the relationship between RFS and preoperative HALP was investigated.
The optimal cutoff value for HALP was determined to be 31.5 by X-tile analysis. HALP was significantly associated with tumor site, tumor size, mitosis, Ki67, National Institutes of Health (NIH) risk category, and adjuvant therapy (all < 0.001). Before PSM, GIST patients with an increased HALP had a significantly poor RFS ( < 0.001), and low HALP was an independent risk factor for poor RFS [hazard ratio (HR): 0.506, 95% confidence interval (95%CI): 0.291-0.879, = 0.016]. In NIH high-risk GIST patients, GIST patients with low HALP had a worse RFS than patients with high HALP ( < 0.05). After PSM, 458 GIST patients were identified; those with an increased HALP still had significantly poor RFS after PSM ( < 0.001) and low HALP was still an independent risk factor for poor RFS (HR: 0.558, 95%CI: 0.319-0.976, = 0.041).
HALP was significantly correlated with postoperative pathology and postoperative treatment. Furthermore, HALP showed a strong ability to predict RFS in GIST patients who underwent radical resection.
血红蛋白、白蛋白、淋巴细胞和血小板联合指数（HALP）可以同时反映全身炎症和营养状况，一些证据显示其对某些肿瘤具有预后价值。然而，HALP 对胃肠道间质瘤（GIST）患者无复发生存率（RFS）的影响尚未报道。
探讨 HALP 在 GIST 患者中的预后价值。
纳入 2008 年 12 月至 2016 年 12 月在华西医院行 R0 切除治疗原发性和局限性 GIST 的 591 例未经治疗患者的数据。记录临床病理数据、术前白蛋白、血常规信息、术后治疗和复发情况。为消除基线不均衡，采用倾向评分匹配（PSM）法。最终，探讨 RFS 与术前 HALP 的关系。
通过 X-tile 分析确定 HALP 的最佳截断值为 31.5。HALP 与肿瘤部位、肿瘤大小、有丝分裂、Ki67、美国国立卫生研究院（NIH）风险类别和辅助治疗显著相关（均<0.001）。在 PSM 之前，HALP 升高的 GIST 患者 RFS 明显较差（<0.001），低 HALP 是 RFS 不良的独立危险因素[风险比（HR）：0.506，95%置信区间（95%CI）：0.291-0.879，=0.016]。在 NIH 高危 GIST 患者中，低 HALP 的 GIST 患者 RFS 较高 HALP 患者更差（<0.05）。PSM 后，确定了 458 例 GIST 患者；PSM 后，HALP 升高的患者 RFS 仍明显较差（<0.001），低 HALP 仍然是 RFS 不良的独立危险因素（HR：0.558，95%CI：0.319-0.976，=0.041）。
HALP 与术后病理和术后治疗密切相关。此外，HALP 对接受根治性切除术的 GIST 患者的 RFS 具有较强的预测能力。
