Analysis of correlation between HALP and pathological features of colon cancer and its effect on liver metastasis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

YANG Limin ,  KUI Guoju

Department of Pathology, The 909th Hospital of Joint Logistic Support Forces (Dongnan Hospital of Xiamen University), Zhangzhou, Fujian 363000, P. R. China;

Corresponding?author：

KUI Guoju, Email: kuiguoju_2005@163.com

Keywords：

hemoglobin; albumin; lymphocyte; platelets; colon cancer; liver metastasis; predictive value

DOI：

10.7507/1007-9424.202303033

Video：

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Objective To investigate the relationship between preoperative hemoglobin, albumin, lymphocyte and platelet (HALP) score, and clinicopathologic features of colon cancer, and to analyze the predictive value of HALP score for postoperative liver metastasis. Methods The clinical data of 163 patients with colon cancer admitted to the 909th Hospital of Joint Logistic Support Force (Dongnan Hospital of Xiamen University) from January 2018 to December 2019 were retrospectively analyzed. According to the occurrence of postoperative liver metastasis, the patients were divided into metastatic group (n=35) and non-metastatic group (n=128). The correlation between preoperative HAPL score and clinicopathologic features of colon cancer was analyzed. The predictive value of HALP score for postoperative liver metastasis of colon cancer was analyzed by using receiver operating characteristic (ROC) curve. The risk factors of liver metastasis after colon cancer surgery were analyzed by using univariate and multivariate logistic analysis. Kaplan-Meier risk curve was drawn, and log-rank test was used to analyze the predictive value of different HALP score for postoperative liver metastasis. Results HALP score were decreased in patients with maximum tumor diameter ≥5 cm, preoperative carcinoembryonic antigen (CEA) ≥5 μg/L, serous membrane and extrasserous infiltration, lymph node metastasis and vascular invasion, and the difference was statistically significant (P<0.05). Multivariate logistic regression analysis showed that HALP score [OR=1.467, 95%CI (1.253, 1.718), P<0.001], maximum tumor diameter [OR=3.476, 95%CI (1.475, 5.358), P=0.013], preoperative CEA level [OR= 6.197, 95%CI (2.436, 6.248), P=0.005], and lymph node metastasis [OR=2.593, 95%CI (1.667, 6.759) , P=0.003] were risk factors for postoperative liver metastasis of colon cancer. ROC curve analysis showed that the area under the curve of HALP score for predicting liver metastasis after colon cancer surgery was 0.908 (0.841, 0.974), the maximum value of the Youden index was 0.738, the optimal cut-off value of the HALP score was 35.5, the sensitivity was 0.852, the specificity was 0.886. Kaplan-Meier risk curve showed that the risk of early postoperative liver metastasis in the low HALP score group was higher than that in the high HALP score group (χ²=8.126, P=0.004). Conclusion Low HALP score in patients with colon cancer is associated with adverse prognosisi related pathological features, and is an influential factor for postoperative liver metastasis of colon cancer, and has predictive value for patients with postoperative liver metastasis of colon cancer.

Citation： YANG Limin, KUI Guoju. Analysis of correlation between HALP and pathological features of colon cancer and its effect on liver metastasis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2023, 30(8): 958-963. doi: 10.7507/1007-9424.202303033 Copy

1.	Global Burden of Disease Cancer Collaboration, Fitzmaurice C, Abate D, et al. Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 29 cancer groups, 1990 to 2017: a systematic analysis for the Global Burden of Disease Study. JAMA Oncol, 2019, 5(12): 1749-1768.
2.	程晨, 吳云樺, 徐正水, 等. Ⅱ~Ⅲ期結腸癌根治術后復發危險因素分析及其列線圖預測模型的應用價值. 中華消化外科雜志, 2021, 20(3): 331-338.
3.	段麗寧, 常寧, 趙亞靜, 等. 血清腫瘤標志物聯合肝功能指標檢測對結腸癌肝轉移的診斷價值. 中華腫瘤防治雜志, 2022, 29(16): 1206-1210.
4.	Giannis D, Sideris G, Kakos CD, et al. The role of liver transplantation for colorectal liver metastases: a systematic review and pooled analysis. Transplant Rev (Orlando), 2022, 34(4): 100570. doi: 10.1016/j.trre.2020.100570.
5.	Wang X, He Q, Liang H, et al. A novel robust nomogram based on preoperative hemoglobin and albumin levels and lymphocyte and platelet counts (HALP) for predicting lymph node metastasis of gastric cancer. J Gastrointest Oncol, 2021, 12(6): 2706-2718.
6.	Feng JF, Wang L, Yang X. The preoperative hemoglobin, albumin, lymphocyte and platelet (HALP) score is a useful predictor in patients with resectable esophageal squamous cell carcinoma. Bosn J Basic Med Sci, 2021, 21(6): 773-781.
7.	Wei S, Shao J, Wang J, et al. The preoperative hemoglobin, albumin, lymphocyte, and platelet score is a prognostic factor for non-small cell lung cancer patients undergoing adjuvant chemotherapy: a retrospective study. Ann Transl Med, 2022, 10(8): 457. doi: 10.21037/atm-22-1097.
8.	Polk N, Budai B, Hitre E, et al. Corrigendum: high neutrophil-to-lymphocyte ratio (NLR) and systemic immune-inflammation index (SII) are markers of longer survival after metastasectomy of patients with liver-only metastasis of rectal cancer. Pathol Oncol Res, 2022, 28: 1610658. doi: 10.3389/pore.2022.1610658.
9.	趙伽木, 張偉, 周洪淵, 等. 結直腸癌肝轉移的最新研究進展. 中華肝臟外科雜志, 2021, 2(27): 156-160.
10.	俞甲子, 張明元, 金梁斌, 等. 結直腸癌不同部位的原發灶對肝轉移瘤根治切除術后早期復發的影響. 中華普通外科雜志, 2022, 37(6): 434-438.
11.	Zhang L, Qiao L, Zhang M, et al. Comparison of prognosis among patients with colorectal cancer liver metastases treated by surgical resection, radiofrequency ablation and HIFU: a protocol for network meta-analysis. Medicine (Baltimore), 2022, 101(33): e27915. doi: 10.1097/MD.0000000000027915.
12.	Zhang L, Zhang Z, Guo H, et al. Systemic immune-inflammation index: a new indicator of predicting 1-, 2-and 3-year disease-free survival of patients with colon cancer. Adv Clin Exp Med, 2022, 32(1): 13-22.
13.	Belcher DA, Lucas A, Cabrales P, et al. Polymerized human hemoglobin facilitated modulation of tumor oxygenation is dependent on tumor oxygenation status and oxygen affinity of the hemoglobin-based oxygen carrier. Sci Rep, 2020, 10(1): 11372. doi: 10.1038/s41598-020-68190-0.
14.	Cheong CM, Golder AM, Horgan PG, et al. Relationship between pre-operative glycated haemoglobin and surgical site infection in patients undergoing elective colon cancer surgery. Oncol Lett, 2022, 24(3): 296. doi: 10.3892/ol.2022.13416.
15.	Xie H, Wei L, Liu M, et al. Neutrophil-albumin ratio as a biomarker for postoperative complications and long-term prognosis in patients with colorectal cancer undergoing surgical treatment. Front Nutr, 2022, 15(9): 976216. doi: 10.3389/fnut.2022.976216.
16.	袁夢依, 王培山, 孟瑞霞, 等. 術前 HALP 評分對老年非小細胞肺癌手術病人預后的預測價值. 實用老年醫學, 2022, 12(36): 1259-1263.
17.	Hajibandeh S, Barghash M, Khan RMA, et al. Predictive significance of tumour size in patients undergoing curative surgery for colorectal cancer: a retrospective cohort study. Cureus, 2022, 14(7): e26656. doi: 10.7759/cureus.26656.
18.	Aylward C, Noori J, Tyrrell J, et al. Survival outcomes after synchronous para-aortic lymph node metastasis in colorectal cancer: a systematic review. J Surg Oncol, 2023, 127(4): 645-656.
19.	段晶晶, 鄧婷, 巴一. 傳統腫瘤標志物在結直腸癌中的應用現狀. 腫瘤綜合治療電子雜志, 2020, 6(2): 1-6.
20.	劉慶睿, 姜憲. 結腸癌肝轉移患者臨床特征及預后危險因素分析: 基于 SEER 數據庫. 消化腫瘤雜志(電子版), 2022, 1(14): 65-70.
21.	Zhao J, Zhu J, Huang C, et al. Impact of primary tumor resection on the survival of patients with unresectable colon cancer liver metastasis at different colonic subsites: a propensity score matching analysis. Acta Chir Belg, 2023, 123(2): 132-147.
22.	Russolillo N, Sperti E, Langella S, et al. Impact of primary tumor location on patterns of recurrence and survival of patients undergoing resection of liver metastases from colon cancer. HPB (Oxford), 2020, 22(1): 116-123.
23.	Hayama T, Ozawa T, Asako K, et al. Impact of colon cancer location on the prognostic significance of nutritional indexes and inflammatory markers. In vivo, 2021, 35(2): 1261-1269.
24.	Mazaki J, Katsumata K, Sujino H, et al. Neutrophil-to-lymphocyte ratio as a prognostic factor for colon cancer in elderly patients: a propensity score analysis. Anticancer Res, 2021, 41(9): 4471-4478.
25.	Xu SS, Li S, Xu HX, et al. Haemoglobin, albumin, lymphocyte and platelet predicts postoperative survival in pancreatic cancer. World J Gastroenterol, 2020, 26(8): 828-838.
26.	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(1): 81-91.
27.	張利, 彭麗麗, 孫寧寧, 等. 治療前HALP評分對Ⅳ期無驅動基因NSCLC患者的預后意義. 現代腫瘤醫學, 2022, 18(30): 3310-3315.

1. Global Burden of Disease Cancer Collaboration, Fitzmaurice C, Abate D, et al. Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 29 cancer groups, 1990 to 2017: a systematic analysis for the Global Burden of Disease Study. JAMA Oncol, 2019, 5(12): 1749-1768.
2. 程晨, 吳云樺, 徐正水, 等. Ⅱ~Ⅲ期結腸癌根治術后復發危險因素分析及其列線圖預測模型的應用價值. 中華消化外科雜志, 2021, 20(3): 331-338.
3. 段麗寧, 常寧, 趙亞靜, 等. 血清腫瘤標志物聯合肝功能指標檢測對結腸癌肝轉移的診斷價值. 中華腫瘤防治雜志, 2022, 29(16): 1206-1210.
4. Giannis D, Sideris G, Kakos CD, et al. The role of liver transplantation for colorectal liver metastases: a systematic review and pooled analysis. Transplant Rev (Orlando), 2022, 34(4): 100570. doi: 10.1016/j.trre.2020.100570.
5. Wang X, He Q, Liang H, et al. A novel robust nomogram based on preoperative hemoglobin and albumin levels and lymphocyte and platelet counts (HALP) for predicting lymph node metastasis of gastric cancer. J Gastrointest Oncol, 2021, 12(6): 2706-2718.
6. Feng JF, Wang L, Yang X. The preoperative hemoglobin, albumin, lymphocyte and platelet (HALP) score is a useful predictor in patients with resectable esophageal squamous cell carcinoma. Bosn J Basic Med Sci, 2021, 21(6): 773-781.
7. Wei S, Shao J, Wang J, et al. The preoperative hemoglobin, albumin, lymphocyte, and platelet score is a prognostic factor for non-small cell lung cancer patients undergoing adjuvant chemotherapy: a retrospective study. Ann Transl Med, 2022, 10(8): 457. doi: 10.21037/atm-22-1097.
8. Polk N, Budai B, Hitre E, et al. Corrigendum: high neutrophil-to-lymphocyte ratio (NLR) and systemic immune-inflammation index (SII) are markers of longer survival after metastasectomy of patients with liver-only metastasis of rectal cancer. Pathol Oncol Res, 2022, 28: 1610658. doi: 10.3389/pore.2022.1610658.
9. 趙伽木, 張偉, 周洪淵, 等. 結直腸癌肝轉移的最新研究進展. 中華肝臟外科雜志, 2021, 2(27): 156-160.
10. 俞甲子, 張明元, 金梁斌, 等. 結直腸癌不同部位的原發灶對肝轉移瘤根治切除術后早期復發的影響. 中華普通外科雜志, 2022, 37(6): 434-438.
11. Zhang L, Qiao L, Zhang M, et al. Comparison of prognosis among patients with colorectal cancer liver metastases treated by surgical resection, radiofrequency ablation and HIFU: a protocol for network meta-analysis. Medicine (Baltimore), 2022, 101(33): e27915. doi: 10.1097/MD.0000000000027915.
12. Zhang L, Zhang Z, Guo H, et al. Systemic immune-inflammation index: a new indicator of predicting 1-, 2-and 3-year disease-free survival of patients with colon cancer. Adv Clin Exp Med, 2022, 32(1): 13-22.
13. Belcher DA, Lucas A, Cabrales P, et al. Polymerized human hemoglobin facilitated modulation of tumor oxygenation is dependent on tumor oxygenation status and oxygen affinity of the hemoglobin-based oxygen carrier. Sci Rep, 2020, 10(1): 11372. doi: 10.1038/s41598-020-68190-0.
14. Cheong CM, Golder AM, Horgan PG, et al. Relationship between pre-operative glycated haemoglobin and surgical site infection in patients undergoing elective colon cancer surgery. Oncol Lett, 2022, 24(3): 296. doi: 10.3892/ol.2022.13416.
15. Xie H, Wei L, Liu M, et al. Neutrophil-albumin ratio as a biomarker for postoperative complications and long-term prognosis in patients with colorectal cancer undergoing surgical treatment. Front Nutr, 2022, 15(9): 976216. doi: 10.3389/fnut.2022.976216.
16. 袁夢依, 王培山, 孟瑞霞, 等. 術前 HALP 評分對老年非小細胞肺癌手術病人預后的預測價值. 實用老年醫學, 2022, 12(36): 1259-1263.
17. Hajibandeh S, Barghash M, Khan RMA, et al. Predictive significance of tumour size in patients undergoing curative surgery for colorectal cancer: a retrospective cohort study. Cureus, 2022, 14(7): e26656. doi: 10.7759/cureus.26656.
18. Aylward C, Noori J, Tyrrell J, et al. Survival outcomes after synchronous para-aortic lymph node metastasis in colorectal cancer: a systematic review. J Surg Oncol, 2023, 127(4): 645-656.
19. 段晶晶, 鄧婷, 巴一. 傳統腫瘤標志物在結直腸癌中的應用現狀. 腫瘤綜合治療電子雜志, 2020, 6(2): 1-6.
20. 劉慶睿, 姜憲. 結腸癌肝轉移患者臨床特征及預后危險因素分析: 基于 SEER 數據庫. 消化腫瘤雜志(電子版), 2022, 1(14): 65-70.
21. Zhao J, Zhu J, Huang C, et al. Impact of primary tumor resection on the survival of patients with unresectable colon cancer liver metastasis at different colonic subsites: a propensity score matching analysis. Acta Chir Belg, 2023, 123(2): 132-147.
22. Russolillo N, Sperti E, Langella S, et al. Impact of primary tumor location on patterns of recurrence and survival of patients undergoing resection of liver metastases from colon cancer. HPB (Oxford), 2020, 22(1): 116-123.
23. Hayama T, Ozawa T, Asako K, et al. Impact of colon cancer location on the prognostic significance of nutritional indexes and inflammatory markers. In vivo, 2021, 35(2): 1261-1269.
24. Mazaki J, Katsumata K, Sujino H, et al. Neutrophil-to-lymphocyte ratio as a prognostic factor for colon cancer in elderly patients: a propensity score analysis. Anticancer Res, 2021, 41(9): 4471-4478.
25. Xu SS, Li S, Xu HX, et al. Haemoglobin, albumin, lymphocyte and platelet predicts postoperative survival in pancreatic cancer. World J Gastroenterol, 2020, 26(8): 828-838.
26. 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(1): 81-91.
27. 張利, 彭麗麗, 孫寧寧, 等. 治療前HALP評分對Ⅳ期無驅動基因NSCLC患者的預后意義. 現代腫瘤醫學, 2022, 18(30): 3310-3315.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Analysis of correlation between HALP and pathological features of colon cancer and its effect on liver metastasis

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