Atjimakul Thiti, Saeaib Nungrutai, Tunthanathip Thara, Thongsuksai Paramee
Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand.
Department of Surgery, Division of Neurosurgery, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand.
World J Oncol. 2024 Apr;15(2):268-278. doi: 10.14740/wjon1778. Epub 2024 Mar 21.
Epithelial ovarian cancer (EOC) is the leading cause of death in gynecological cancers in developed countries. In recent years, there has been a growing need for economical and accurate pretreatment laboratory investigations to assess the prognosis of patients with advanced EOC (AEOC). We aimed to investigate the role of the hemoglobin-albumin-lymphocyte-platelet (HALP) index in suboptimal cytoreduction and oncological outcomes.
A prognostic prediction model for diagnosing suboptimal cytoreduction for patients with AEOC receiving neoadjuvant chemotherapy (NACT) was developed. Multivariate logistic regression analysis was performed to identify the independent predictors of suboptimal cytoreduction, with a P-value < 0.05, and then transformed into risk-scoring systems. Internal validation was performed using the bootstrapping procedure, and predictive cytoreduction (PSC) scores were compared using non-parametric receiver operating characteristic (ROC) regression. Survival analysis was performed using Kaplan-Meier estimation and Cox proportional regression.
In total, 473 patients were analyzed, and the rate of suboptimal surgery was 43%. A scoring system in predicting suboptimal cytoreduction included age, cancer antigen (CA)-125 level before surgery, performance status, cycles of chemotherapy, peritoneal cancer index, and HALP index ≤ 22.6. The model had good discriminative ability (area under the ROC (AUROC), 0.80; 95% confidence interval (CI), 0.76 - 0.84), outperforming the PSC score (AUROC, 0.75; 95% CI, 0.71 - 0.80). The score was divided into the low-risk (positive predictive value (PPV), 22.4; 95% CI, 17.8 - 27.7), moderate-risk (PPV, 65.9; 95% CI, 56.9 - 74.0), and high-risk (PPV, 90.6; 95% CI, 79.3 - 96.9) groups. The HALP index score of ≤ 22.6 was independently associated with progression-free survival (hazard ratio (HR), 2.92; 95% CI, 1.58 - 5.40) and overall survival (HR, 2.66; 95% CI, 1.57 - 4.49).
The HALP index is a newly predicted factor for suboptimal cytoreduction and oncological outcomes in patients with AEOC after NACT.
上皮性卵巢癌（EOC）是发达国家妇科癌症死亡的主要原因。近年来，对于评估晚期EOC（AEOC）患者预后的经济且准确的预处理实验室检查的需求日益增长。我们旨在研究血红蛋白-白蛋白-淋巴细胞-血小板（HALP）指数在次优细胞减灭术和肿瘤学结局中的作用。
建立了一个用于诊断接受新辅助化疗（NACT）的AEOC患者次优细胞减灭术的预后预测模型。进行多因素逻辑回归分析以确定次优细胞减灭术的独立预测因素，P值<0.05，然后将其转化为风险评分系统。使用自举程序进行内部验证，并使用非参数接受者操作特征（ROC）回归比较预测性细胞减灭术（PSC）评分。使用Kaplan-Meier估计和Cox比例回归进行生存分析。
总共分析了473例患者，次优手术率为43%。预测次优细胞减灭术的评分系统包括年龄、术前癌抗原（CA）-125水平、体能状态、化疗周期、腹膜癌指数和HALP指数≤22.6。该模型具有良好的判别能力（ROC曲线下面积（AUROC），0.80；95%置信区间（CI），0.76 - 0.84），优于PSC评分（AUROC，0.75；95%CI，0.71 - 0.80）。该评分分为低风险（阳性预测值（PPV），22.4；95%CI，17.8 - 27.7）、中度风险（PPV，65.9；95%CI，56.9 - 74.0）和高风险（PPV，90.6；95%CI，79.3 - 96.9）组。HALP指数评分≤22.6与无进展生存期（风险比（HR），2.92；95%CI，1.58 - 5.40）和总生存期（HR，2.66；95%CI，1.57 - 4.49）独立相关。
HALP指数是NACT后AEOC患者次优细胞减灭术和肿瘤学结局的一个新的预测因素。
