Prognostic Significance Of The Pre-treatment Hemoglobin, Albumin, Lymphocyte, And Platelet (HALP) Score In Small Cell Lung Cancer Patients Undergoing First-line Treatment

Background and purpose:Small cell lung cancer(SCLC)is a major type of lung cancer with neuroendocrine tumor characteristics.SCLC is highly responsive to chemotherapy and radiotherapy,but it is also easy to harbor drug resistance and relapse.Therefore,searching for clinically accessible indicators such as blood parameters to predict the therapeutic effect and to determine the prognosis of patients with SCLC is one of the most urgent clinical problems.The hemoglobin,albumin,lymphocyte,and platelet(HALP)score reflects the nutritional and immune status of the patient,which is a prognostic factor in patients who have malignant tumors,but its prognostic role in SCLC remains unclear.Therefore,this study aims to investigate the prognostic significance of the HALP score in SCLC patients before first-line treatment with etoposide.Methods:A retrospective study included 178 patients with SCLC who received first-line chemotherapy with etoposide between September 2015 and May 2019 from Provincial Hospital Affiliated to Anhui Medical University.Clinical data collected including age,gender,body mass index(BMI),tumor stage,first-line chemotherapy treatment regimens,first evaluation results,radiotherapy condition,and the reason for tumor progression.Hematologic parameters including serum albumin,hemoglobin,lymphocytes and platelets were collected as well.The HALP score was calculated according to the following formula:hemoglobin(g/L)×albumin(g/L)×lymphocytes(/L)/platelets(/L).Statistical analysis was used to identify the factors associated with progression-free survival(PFS).Results:The median PFS of first-line treatment was 6.05 months,and the optimal cut-off values of the HALP score was determined by X-tile software to be 25.8.Patients in the high HALP score(HALP score>25.8)group had a longer PFS than the low HALP score(HALP score?25.8)group(P=0.0036).Univariate and multivariate analysis showed that in 178 patients,the HALP score(HR,0.777;95%CI;0.544-1.112)(P=0.168),body mass index(BMI),and serum albumin levels(HR,0.917;95%CI,0.672-1.252)(P=0.587)had no prognostic significance.In the patient age group<65years,a BMI?24 kg/m~2(HR,1.943;95%CI,1.251-3.018)(P=0.003)was an independent prognostic factor.In the patient age group?65 years,a HALP score>25.8(HR,0.483;95%CI,0.270-0.865)(P=0.014)was an independent positive prognostic factor for outcome following first-line treatment with etoposide.Conclusion:In SCLC patients undergoing etoposide combined with platinum as a first-line treatment,the HALP score has prognostic significance.Especially in patients?65 years,a HALP score>25.8 was an independent predictor of improved outcome,associated with increased PFS.