The Effect of the HALP Score on the Development of Bladder Cancer Recurrence in Patients Undergoing Radical Nephroureterectomy for Upper Urinary Tract Tumours

Abstract

Background We aimed to investigate the effect of the haemoglobin, albumin, lymphocyte and platelet (HALP) score on pathologic results and bladder cancer recurrence (BCR) in patients operated for upper urinary tract tumours (UTUCs).

Material and Methods HALP scores of all patients were calculated. Demographic data, preoperative blood parameters, pathologic data and the BCR development status of patients with low and high HALP scores were compared.

Results Haemoglobin (11.2±2.3 g/dL vs. 12.9±2.4 g/dL), albumin (4.0±0.8 g/dL vs. 4.4±0.9 g/dL) and HALP score (38.2±2.9 vs. 43.4±3.1) were statistically lower in the BCR (+) group compared with the BCR (–) group (p<0.001). The ROC curve showed that the optimal cut-off point for the HALP score was 40.8. Multivariate analyses showed that the HALP score was effective on Tumour Grade, Tumour Stage, BCR.

Conclusion We have shown that patients with lower HALP scores have a more advanced stage and higher-grade pathologic outcomes and have a higher risk of developing BCR.

Zusammenfassung

Hintergrund Unser Ziel war es, die Wirkung von Hämoglobin, Albumin, Lymphozyten und Blutplättchen Scores± (HALP) auf pathologische Ergebnisse und auf das Wiederauftreten von Blasenkrebs (BCR) bei Patienten zu untersuchen, die wegen Tumoren der oberen Harnwege (UTUCs) operiert wurden.

Material und Methoden HALP-Scores aller Patienten wurden berechnet. Demografische Daten, präoperative Blutparameter, pathologische Daten und der BCR-Entwicklungsstatus von Patienten mit niedrigen und hohen HALP-Werten wurden verglichen.

Ergebnisse Hämoglobulin (11,2±2,3d/dL vs. 12,9±2,4g/dL), Albumin (4,0±0,8 g/dL vs. 4,4±0,9 g/dL) und HALP-Score (38,2±2,9 vs. 43,4±3,1) waren statistisch niedriger in der BCR-Gruppe (+) im Vergleich zur BCR-Gruppe (–) (p<0,001). Die ROC-Kurve zeigte, dass der optimale Grenzwert für den HALP-Score bei 40,8 lag. Die multivariate Analyse zeigte dann, dass Tumorgrad, Tumorstadium und BCR signifikante Faktoren für den HALP-Score waren.

Schlussfolgerung Wir haben gezeigt, dass Patienten mit niedrigeren HALP-Werten pathologische Ergebnisse in einem fortgeschritteneren und höhergradigen Stadium aufweisen und ein höheres Risiko für die Entwicklung einer BCR haben.

Keywords

HALP score - bladder cancer - recurrence - upper tract urothelial carcinoma

Schlüsselwörter

Blasenkrebs - Rezidiv - HALP-Score - Urothelkarzinom des oberen Harntrakts

• References

• 1 Rouprêt M, Seisen T, Birtle AJ. et al. European Association of Urology Guidelines on Upper Urinary Tract Urothelial Carcinoma: 2023 Update. Eur Urol 2023; 84: 49-64
• 2 Tian C, Liu J, An L. et al. Prognostic nomogram for overall survival in upper urinary tract urothelial carcinoma (UTUC) patients treated with chemotherapy: a SEER-based retrospective cohort study. BMC Urol 2023; 23: 2
• 3 Cheng TH, Hu CY, Wu KY. et al. Preexisting renal insufficiency synchronous with high preoperative neutrophiltolymphocyte ratio as a risk factor of intravesical recurrence in patients with pure upper tract urothelial carcinoma after radical nephroureterectomy. Exp Ther Med 2022; 24: 671
• 4 Xia Z, Fu X, Li J. et al. Prognostic value of pretreatment serum albumin-globulin ratio in urothelial carcinoma: A systematic review and meta-analysis. Front Oncol 2022; 12: 992118
• 5 Luo Z, Jiao B, Huang T. et al. What is the Role of the Preoperative Blood-Based Inflammation Biomarkers in the Prognosis of Upper Tract Urothelial Carcinoma With Radical Nephroureterectomy? A Single-Centre Retrospective Study. Technol Cancer Res Treat 2022; 21 15330338221095667
• 6 Liu J, Wu P, Lai S. et al. Prognostic models for upper urinary tract urothelial carcinoma patients after radical nephroureterectomy based on a novel systemic immune-inflammation score with machine learning. BMC Cancer 2023; 23: 574
• 7 Egger V, Hutterer GC, Mischinger J. et al. Preoperative fibrinogen/CRP score predicts survival in upper urothelial tract carcinoma patients undergoing radical curative surgery. World J Urol 2023; 41: 1359-1364
• 8 Guo Y, Shi D, Zhang J. et al. The Hemoglobin, Albumin, Lymphocyte, and Platelet (HALP) Score is a Novel Significant Prognostic Factor for Patients with Metastatic Prostate Cancer Undergoing Cytoreductive Radical Prostatectomy. J Cancer 2019; 10: 81-91
• 9 Jiang H, Li H, Li A. et al. Preoperative combined hemoglobin, albumin, lymphocyte and platelet levels predict survival in patients with locally advanced colorectal cancer. Oncotarget 2016; 7: 72076-72083
• 10 Peng D, Zhang C, Tang Q. et al. Prognostic significance of the combination of preoperative hemoglobin and albumin levels and lymphocyte and platelet counts (HALP) in patients with renal cell carcinoma after nephrectomy. BMC Urol 2018; 18: 20
• 11 Peng D, Zhang C, Gong Y. et al. Prognostic significance of HALP (hemoglobin, albumin, lymphocyteand platelet) in patients with bladder cancer after radical cystectomy. SciRep 2018; 8: 794
• 12 Ekinci F, Balcik OY, Oktay E. et al. HALP Score as a New Prognostic Index in Metastatic Renal Cell Cancer. J Coll Physicians Surg Pak 2022; 32: 313-318
• 13 Killock D. New standard for localized UTUC. Nat Rev Urol 2020; 17: 370
• 14 Gao X, Ma Y, Chen G. et al. Concomitant carcinoma in situ as a prognostic factor in the upper tract urothelial carcinoma after radical nephroureterectomy: A systematic review and meta-analysis. Urol Oncol 2020; 38: 574-581
• 15 Mori K, Janisch F, Mostafaei H. et al. Prognostic value of preoperative blood-based biomarkers in upper tract urothelial carcinoma treated with nephroureterectomy: A systematic review and meta-analysis. Urol Oncol 2020; 38: 315-333
• 16 Rink M, Sharifi N, Fritsche HM. et al. Impact of preoperative anemia on oncologic outcomes of upper tract urothelial carcinoma treated with radical nephroureterectomy. J Urol 2014; 191: 316-322
• 17 Xia L, Hu G, Guzzo TJ. Prognostic Significance of Preoperative Anemia in Patients Undergoing Surgery for Renal Cell Carcinoma: A Meta-analysis. Anticancer Res 2017; 37: 3175-3181
• 18 Milojevic B, Bumbasirevic U, Santric V. et al. Prognostic significance of tumor multifocality on outcomes in patients with upper tract urothelial carcinoma after radical nephroureterectomy: A cohort study. Curr Probl Cancer 2021; 45: 100747
• 19 Corcoran AT, Kaffenberger SD, Clark PE. et al. Hypoalbuminaemia is associated with mortality in patients undergoing cytoreductive nephrectomy. BJU Int 2015; 116: 351-357
• 20 Ku JH, Kim M, Choi WS. et al. Preoperative serum albumin as a prognostic factor in patients with upper urinary tract urothelial carcinoma. Int Braz J Urol 2014; 40: 753-762
• 21 Zhao J, Huang W, Wu Y. et al. Prognostic role of pretreatment blood lymphocyte count in patients with solid tumors: A systematic review and meta-analysis. Cancer Cell Int 2020; 20: 1-14
• 22 Zhang GM, Zhu Y, Luo L. et al. Preoperative lymphocyte-monocyte and platelet-lymphocyte ratios as predictors of overall survival in patients with bladder cancer undergoing radical cystectomy. Tumour Biol 2015; 36: 8537-8543
• 23 Chien TM, Li CC, Lu YM. et al. The Predictive Value of Systemic Immune-Inflammation Index on Bladder Recurrence on Upper Tract Urothelial Carcinoma Outcomes after Radical Nephroureterectomy. J Clin Med 2021; 10: 5273
• 24 Chen X, Xue L, Wang W. et al. Prognostic significance of the combination of preoperative hemoglobin, albumin, lymphocyte and platelet in patients with gastric carcinoma: a retrospective cohort study. Oncotarget 2015; 6: 41370-41382
• 25 Gao X, Lin B, Lin Q. et al. A HALP score-based prediction model for survival of patients with the upper tract urothelial carcinoma undergoing radical nephroureterectomy. Bosn J Basic Med Sci 2022; 22: 280-290