HALP index prognostic significance for colon cancer patients in a Hispanic-based population.
Authors: Guijosa Alberto , Calderillo-Ruiz German , Munoz Montano Wendy Rossemary , Vazquez Renteria Rafael Sebastian , Castillo Morales Carolina , Herrera Marytere , Diaz Consuelo , Vazquez Cortés Ezequiel , Castillo Morales Alison , Lopez Basave Horacio 
Published: June 2022

e15521 Background: In locoregional colon cancer, interindividual survival and recurrence rates following surgical resection are highly variable and not solely dependent on cancer anatomic extent. The HALP (hemoglobin, albumin, lymphocyte and platelet) index was recently developed to assess prognosis with greater accuracy. In the present work, we evaluate, for the first time, the prognostic value of the HALP index in Hispanic colon cancer patients. Methods: We conducted a retrospective cohort study in Mexican patients with histologically confirmed stage I–III primary colonic adenocarcinoma who underwent radical surgical resection at Mexico’s National Institute of Cancer, between 2008 and 2020. We collected clinical and pathological variables from electronic medical records for all included patients. We determined preoperative HALP score [hemoglobin level (g/L) × albumin level (g/L) × lymphocyte count (/L) / platelet count (/L)] optimal cut-off value by using the X-tile software. We plotted survival curves using the Kaplan-Meier method, and performed a multivariate Cox regression analysis to explore the association of the dichotomized preoperative HALP score with two primary endpoints: overall survival (OS) and disease-free survival (DFS). We also explored the association of all collected variables with both the dichotomized HALP score and our primary endpoints. Results: We included 640 patients (49.8% females). The most prevalent age group was 40-70 years and pathological TNM (pTNM) stages II and III represented most of our population (43.1% and 45.2% respectively). The optimal HALP cut-off value was 15.0, classifying patients into low or high HALP score. In the Kaplan-Meier analysis, low HALP score was significantly associated with shorter median OS (73.5 vs. 84.8 months; log-rank test p = 0.013). Multivariate Cox regression analysis established that a low HALP score is an independent factor associated with shorter OS (HR = 1.942, 95% CI = 1.647-2.875; p = 0.031). There was no significant association between HALP score and DFS. HALP index was statistically significantly associated with pTNM stage, tumor differentiation, colon cancer location and BMI. Surgical margin status and pTNM stage were significantly associated with OS. Cancer perforation was significantly associated with DFS. Conclusions: Our findings suggest that HALP index is a viable preoperative predictor of survival for Hispanic patients, despite recurrence. It seems to reflect both the anatomical extent of the disease, and traditionally unaccounted nutritional and inflammatory factors that are significant for prognosis. Since this index is computed through widely-available parameters, its adoption in clinical practice could significantly benefit developing countries, such as those in Latin America. We provide a cut-off value that can be used in Hispanic colon cancer patients to assess prognosis and guide management.