A HALP score-based prediction model for survival of patients with the upper tract urothelial carcinoma undergoing radical nephroureterectomy

The HALP score, which is the combination of hemoglobin, albumin, lymphocyte, and platelets has been confirmed as an important risk biomarker in several cancers. We aimed at evaluating the prognostic value of the HALP score in patients with non-metastatic upper tract urothelial carcinoma (UTUC). In this study, we retrospectively enrolled 533 of the 640 patients from two centers (315 and 325 patients, respectively) who underwent radical nephroureterectomy (RNU) for UTUC. The cutoff value of HALP was determined using the Youden index by performing receiver operating characteristic curve analysis. The relationship between post-operative survival outcomes and pre-operative HALP level was assessed using Kaplan-Meier and Cox regression analyses. As a result, the cutoff value of HALP was 28.67 and patients were then divided into HALP <28.67 group and HALP >= 28.67 group. Kaplan-Meier analysis and log-rank test revealed that HALP was significantly associated with overall survival (OS) (p < 0.001) and progression-free survival (PFS) (p < 0.001). Multivariate analysis demonstrated that a lower HALP score was an independent risk factor for OS (HR =1.54, 95% CI, 1.14-2.01, p = 0.006) and PFS (HR =1.44, 95% CI, 1.07-1.93, p = 0.020). Nomograms of OS and PFS incorporated with HALP score were more accurate in predicting prognosis than without it. The HALP score could also stratify patients for survival under different pathologic T stages in the subgroup analysis. Therefore, pretreatment HALP score was an independent prognostic factor of OS and PFS in UTUC patients undergoing RNU.