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Metastatik küçük hücreli akciğer kanserinde kan temelli öngördürücüler olarak HALP ve SII

Year 2026, Volume: 8 Issue: 1, 17 - 22, 06.01.2026
https://doi.org/10.38053/acmj.1797808

Abstract

Gerekçe/Amaç
Küçük hücreli akciğer kanseri (SCLC), sınırlı sağkalım süresiyle seyreden agresif bir malignitedir ve kolay ulaşılabilir prognostik belirteçlere duyulan ihtiyacı ortaya koymaktadır. Bu çalışma, Hemoglobin, Albümin, Lenfosit ve Trombosit (HALP) skoru ile Sistemik İmmün-İnflamasyon İndeksi’nin (SII) SCLC hastalarındaki prognostik değerini değerlendirmeyi amaçlamıştır.

Yöntem
Metastatik SCLC tanısı almış 132 hasta retrospektif olarak analiz edilmiştir. Başlangıç laboratuvar verileri kullanılarak HALP ve SII skorları hesaplanmıştır. ROC analizi ile optimal kesim değerleri belirlenmiştir. Sağkalım sonuçları Kaplan–Meier ve Cox regresyon analizleriyle değerlendirilmiştir.

Bulgular
HALP için optimal kesim değeri 17,23; SII için 747,27 olarak bulunmuştur. Yüksek SII düzeyi, progresyonsuz sağkalımın (PFS) daha kısa olmasının bağımsız bir öngördürücüsü olarak saptanmıştır (HR = 1,82, p = 0,04), ancak genel sağkalımı (OS) öngörmemiştir. HALP, 6 aylık sağkalımı öngörmede anlamlı bulunmuştur (AUC: 0,61, p = 0,04), ancak OS veya PFS üzerinde anlamlı bir etkisi gözlenmemiştir. Karaciğer (HR = 1,72, p = 0,04) ve beyin metastazı (HR = 1,74, p = 0,02) varlığı, PFS’nin daha kısa olmasının bağımsız belirteçleri olarak belirlenmiştir.

Sonuç
SII, SCLC hastalarında PFS için güvenilir bir prognostik belirteç olabilirken, HALP sınırlı bir öngörü gücüne sahiptir. Özellikle karaciğer ve beyin metastazlarının varlığı prognozu anlamlı şekilde etkilemektedir. Bu bulguların doğrulanması için daha geniş ve prospektif çalışmalara ihtiyaç vardır.

Ethical Statement

Çalışmamız için etik onay, Dr. Abdurrahman Yurtaslan Ankara Onkoloji Eğitim ve Araştırma Hastanesi Girişimsel Olmayan Klinik Araştırmalar Etik Kurulu’ndan alınmıştır (onay numarası: 2025-10/149).

Supporting Institution

Çalışmamızı destekleyen herhangi bir kurum veya finansal destek yoktur.

References

  • Shen XB, Zhang YX, Wang W, Pan YY. The Hemoglobin, albumin, lymphocyte, and platelet (HALP) score in patients with small cell lung cancer before first-line treatment with etoposide and progression-free survival. Med Sci Monit. 2019;25:5630-5639. doi:10.12659/MSM.917968
  • Zimmerman S, Das A, Wang S, Julian R, Gandhi L, Wolf J. 2017-2018 scientific advances in thoracic oncology: small cell lung cancer. J Thorac Oncol. 2019;14(5):768-783. doi:10.1016/j.jtho.2019.01.022
  • Gazdar AF, Bunn PA, Minna JD. Small-cell lung cancer: what we know, what we need to know and the path forward. Nat Rev Cancer. 2017;17 (12):725-737. doi:10.1038/nrc.2017.87
  • Schiessel DL, Baracos VE. Barriers to cancer nutrition therapy: excess catabolism of muscle and adipose tissues induced by tumour products and chemotherapy. Proc Nutr Soc. 2018;77(4):394-402. doi:10.1017/S0029665118000186
  • 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(44):72076-72083. doi:10. 18632/oncotarget.12271
  • Hamakawa Y, Hirahara A, Hayashi A, et al. Prognostic value of systemic immune-inflammation index in patients with small-cell lung cancer treated with immune checkpoint inhibitors. BMC Cancer. 2025;25(1):17. doi:10.1186/s12885-025-13440-5
  • Diakos CI, Charles KA, McMillan DC, Clarke SJ. Cancer-related inflammation and treatment effectiveness. Lancet Oncol. 2014;15(11): e493-503. doi:10.1016/S1470-2045(14)70263-3
  • Hu B, Yang XR, Xu Y, et al. Systemic Immune-inflammation Index predicts prognosis of patients after curative resection for hepatocellular carcinoma. Clin Cancer Res. 2014;20(23):6212-6222. doi:10.1158/1078-0432.CCR-14-0442
  • Liu J, Li S, Zhang S, et al. Systemic Immune-inflammation index, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio can predict clinical outcomes in patients with metastatic non-small-cell lung cancer treated with nivolumab. J Clin Lab Anal. 2019;33(8):e22964. doi:10.1002/jcla.22964
  • Winther-Larsen A, Aggerholm-Pedersen N, Sandfeld-Paulsen B. Inflammation scores as prognostic biomarkers in small cell lung cancer: a systematic review and meta-analysis. Syst Rev. 2021;10(1):40. doi:10. 1186/s13643-021-01585-w
  • Yilmaz H, Yersal Ö. Prognostic significance of novel inflammatory markers in extensive-stage small-cell lung cancer. J Cancer Res Ther. 2022;18(3):691-696. doi:10.4103/jcrt.jcrt_1937_21
  • Yang Y, Li J, Wang Y, Luo L, Yao Y, Xie X. Prognostic value of the Systemic Immune-inflammation Index in lung cancer patients receiving immune checkpoint inhibitors: a meta-analysis. PLoS One. 2024;19(11):e0312605. doi:10.1371/journal.pone.0312605
  • Wang Y, Li Y, Chen P, Xu W, Wu Y, Che G. Prognostic value of the pretreatment Systemic Immune-inflammation Index (SII) in patients with non-small cell lung cancer: a meta-analysis. Ann Transl Med. 2019; 7(18):433. doi:10.21037/atm.2019.08.116
  • Zhang Z, Zhao Y, Wen J, Wang Y, Li J. Impact of Systemic Immune-inflammation Index and its evaluation of optimal threshold in patients with limited-stage small cell lung cancer: a retrospective study based on 572 cases. Transl Cancer Res. 2025;14(1):371-382. doi:10.21037/tcr-24-1266
  • 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. doi:10.17305/bjbms.2021.5666
  • Li Q, Chen M, Zhao H, Zeng J. The prognostic and clinicopathological value of HALP score in non-small cell lung cancer. Front Immunol. 2025;16:1576326. doi:10.3389/fimmu.2025.1576326
  • Zhang T, Liu W, Xu C. Correlation analysis of hemoglobin, albumin, lymphocyte, platelet score and platelet to albumin ratio and prognosis in patients with lung adenosquamous carcinoma. Front Oncol. 2023;13:116 6802. doi:10.3389/fonc.2023.1166802
  • Yang N, Han X, Yu J, Shu W, Qiu F, Han J. Hemoglobin, albumin, lymphocyte, and platelet score and neutrophil-to-lymphocyte ratio are novel significant prognostic factors for patients with small-cell lung cancer undergoing chemotherapy. J Cancer Res Ther. 2020;16(5):1134-1139. doi:10.4103/jcrt.JCRT_1066_19
  • Yang R, Chang Q, Meng X, Gao N, Wang W. Prognostic value of Systemic Immune-inflammation Index in cancer: a meta-analysis. J Cancer. 2018;9(18):3295-3302. doi:10.7150/jca.25691
  • Kagohashi K, Satoh H, Ishikawa H, Ohtsuka M, Sekizawa K. Liver metastasis at the time of initial diagnosis of lung cancer. Med Oncol. 2003;20(1):25-28. doi:10.1385/MO:20:1:25
  • Zhang S, Wang Y, Li S, Liu Y, Cheng Y. A retrospective analysis of prognostic factors and treatment choices in small cell lung cancer with liver metastasis. J Thorac Dis. 2023;15(12):6776-6787. doi:10.21037/jtd-23-1294
  • Lin Y, Jiang W, Su CY, Pan XB. Impact of liver metastases status on survival outcomes of first-line immunotherapy in extensive stage small cell lung cancer: a systematic review and meta-analysis. Aging (Albany NY). 2023;15(18):9561-9571. doi:10.18632/aging.205035
  • Chaung KV, Kharouta MZ, Gross AJ, et al. Outcomes of initial therapy for synchronous brain metastases from small cell lung cancer: a single-institution retrospective analysis. Transl Lung Cancer Res. 2024;13(5): 1110-1120. doi:10.21037/tlcr-23-641

HALP and SII as blood-based predictors in metastatic small-cell lung cancer

Year 2026, Volume: 8 Issue: 1, 17 - 22, 06.01.2026
https://doi.org/10.38053/acmj.1797808

Abstract

Aims: Small cell lung cancer (SCLC) is an aggressive malignancy with limited survival, underscoring the need for accessible prognostic markers. This study aimed to evaluate the prognostic value of the hemoglobin, albumin, lymphocyte, and platelet (HALP) score and the Systemic Immune-inflammation Index (SII) in patients with SCLC.
Methods: We retrospectively analyzed 132 patients diagnosed with metastatic SCLC. Baseline laboratory data were used to calculate HALP and SII scores. Optimal cut-off values were determined by ROC analysis. Survival outcomes were assessed using Kaplan-Meier and Cox regression analyses.
Results: The optimal cut-off values were 17.23 for HALP (AUC: 0.611, 95% CI: 0.50-0.72, p=0.04) and 747.27 for SII (AUC: 0.628, p=0.02, 95% CI: 0.52–0.73). High SII was an independent predictor of shorter progression-free survival (PFS) (HR=1.82, 95% CI: 1.02–3.26, p=0.04), but not overall survival (OS). HALP score predicted 6-month survival but showed no significant effect on OS or PFS. Liver (HR=1.72, 95% CI: 1.02-2.90, p=0.04) and brain metastases (HR=1.74, 95% CI: 1.08-2.80, p=0.02) were independent predictors of shorter PFS.
Conclusion: SII may serve as a reliable prognostic marker for PFS in SCLC, while HALP showed limited predictive value. Metastatic sites, particularly liver and brain involvement, significantly impact prognosis. Larger, prospective studies are needed to validate these findings.

Ethical Statement

For our study, ethical approval was obtained from the Non-Interventional Clinical Research Ethics Committee of Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital (approval number: 2025-10/149).

Supporting Institution

There is no funding or institutional support for this study.

References

  • Shen XB, Zhang YX, Wang W, Pan YY. The Hemoglobin, albumin, lymphocyte, and platelet (HALP) score in patients with small cell lung cancer before first-line treatment with etoposide and progression-free survival. Med Sci Monit. 2019;25:5630-5639. doi:10.12659/MSM.917968
  • Zimmerman S, Das A, Wang S, Julian R, Gandhi L, Wolf J. 2017-2018 scientific advances in thoracic oncology: small cell lung cancer. J Thorac Oncol. 2019;14(5):768-783. doi:10.1016/j.jtho.2019.01.022
  • Gazdar AF, Bunn PA, Minna JD. Small-cell lung cancer: what we know, what we need to know and the path forward. Nat Rev Cancer. 2017;17 (12):725-737. doi:10.1038/nrc.2017.87
  • Schiessel DL, Baracos VE. Barriers to cancer nutrition therapy: excess catabolism of muscle and adipose tissues induced by tumour products and chemotherapy. Proc Nutr Soc. 2018;77(4):394-402. doi:10.1017/S0029665118000186
  • 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(44):72076-72083. doi:10. 18632/oncotarget.12271
  • Hamakawa Y, Hirahara A, Hayashi A, et al. Prognostic value of systemic immune-inflammation index in patients with small-cell lung cancer treated with immune checkpoint inhibitors. BMC Cancer. 2025;25(1):17. doi:10.1186/s12885-025-13440-5
  • Diakos CI, Charles KA, McMillan DC, Clarke SJ. Cancer-related inflammation and treatment effectiveness. Lancet Oncol. 2014;15(11): e493-503. doi:10.1016/S1470-2045(14)70263-3
  • Hu B, Yang XR, Xu Y, et al. Systemic Immune-inflammation Index predicts prognosis of patients after curative resection for hepatocellular carcinoma. Clin Cancer Res. 2014;20(23):6212-6222. doi:10.1158/1078-0432.CCR-14-0442
  • Liu J, Li S, Zhang S, et al. Systemic Immune-inflammation index, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio can predict clinical outcomes in patients with metastatic non-small-cell lung cancer treated with nivolumab. J Clin Lab Anal. 2019;33(8):e22964. doi:10.1002/jcla.22964
  • Winther-Larsen A, Aggerholm-Pedersen N, Sandfeld-Paulsen B. Inflammation scores as prognostic biomarkers in small cell lung cancer: a systematic review and meta-analysis. Syst Rev. 2021;10(1):40. doi:10. 1186/s13643-021-01585-w
  • Yilmaz H, Yersal Ö. Prognostic significance of novel inflammatory markers in extensive-stage small-cell lung cancer. J Cancer Res Ther. 2022;18(3):691-696. doi:10.4103/jcrt.jcrt_1937_21
  • Yang Y, Li J, Wang Y, Luo L, Yao Y, Xie X. Prognostic value of the Systemic Immune-inflammation Index in lung cancer patients receiving immune checkpoint inhibitors: a meta-analysis. PLoS One. 2024;19(11):e0312605. doi:10.1371/journal.pone.0312605
  • Wang Y, Li Y, Chen P, Xu W, Wu Y, Che G. Prognostic value of the pretreatment Systemic Immune-inflammation Index (SII) in patients with non-small cell lung cancer: a meta-analysis. Ann Transl Med. 2019; 7(18):433. doi:10.21037/atm.2019.08.116
  • Zhang Z, Zhao Y, Wen J, Wang Y, Li J. Impact of Systemic Immune-inflammation Index and its evaluation of optimal threshold in patients with limited-stage small cell lung cancer: a retrospective study based on 572 cases. Transl Cancer Res. 2025;14(1):371-382. doi:10.21037/tcr-24-1266
  • 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. doi:10.17305/bjbms.2021.5666
  • Li Q, Chen M, Zhao H, Zeng J. The prognostic and clinicopathological value of HALP score in non-small cell lung cancer. Front Immunol. 2025;16:1576326. doi:10.3389/fimmu.2025.1576326
  • Zhang T, Liu W, Xu C. Correlation analysis of hemoglobin, albumin, lymphocyte, platelet score and platelet to albumin ratio and prognosis in patients with lung adenosquamous carcinoma. Front Oncol. 2023;13:116 6802. doi:10.3389/fonc.2023.1166802
  • Yang N, Han X, Yu J, Shu W, Qiu F, Han J. Hemoglobin, albumin, lymphocyte, and platelet score and neutrophil-to-lymphocyte ratio are novel significant prognostic factors for patients with small-cell lung cancer undergoing chemotherapy. J Cancer Res Ther. 2020;16(5):1134-1139. doi:10.4103/jcrt.JCRT_1066_19
  • Yang R, Chang Q, Meng X, Gao N, Wang W. Prognostic value of Systemic Immune-inflammation Index in cancer: a meta-analysis. J Cancer. 2018;9(18):3295-3302. doi:10.7150/jca.25691
  • Kagohashi K, Satoh H, Ishikawa H, Ohtsuka M, Sekizawa K. Liver metastasis at the time of initial diagnosis of lung cancer. Med Oncol. 2003;20(1):25-28. doi:10.1385/MO:20:1:25
  • Zhang S, Wang Y, Li S, Liu Y, Cheng Y. A retrospective analysis of prognostic factors and treatment choices in small cell lung cancer with liver metastasis. J Thorac Dis. 2023;15(12):6776-6787. doi:10.21037/jtd-23-1294
  • Lin Y, Jiang W, Su CY, Pan XB. Impact of liver metastases status on survival outcomes of first-line immunotherapy in extensive stage small cell lung cancer: a systematic review and meta-analysis. Aging (Albany NY). 2023;15(18):9561-9571. doi:10.18632/aging.205035
  • Chaung KV, Kharouta MZ, Gross AJ, et al. Outcomes of initial therapy for synchronous brain metastases from small cell lung cancer: a single-institution retrospective analysis. Transl Lung Cancer Res. 2024;13(5): 1110-1120. doi:10.21037/tlcr-23-641
There are 23 citations in total.

Details

Primary Language English
Subjects Clinical Oncology
Journal Section Research Article
Authors

Berkan Karabuğa 0000-0001-5357-7610

Mehmet Emin Yılmaz This is me 0000-0002-2361-6591

Mustafa Büyükkör 0000-0002-3458-525X

Ekin Konca Karabuğa This is me 0000-0001-9946-1250

Ergin Aydemir 0000-0003-0498-6308

Osman Bilge Kaya This is me 0000-0002-9795-8631

Sedef Tatar Bolat This is me 0000-0003-0593-6329

İlknur Deliktaş Onur 0000-0001-9884-5789

Öztürk Ateş 0000-0003-0182-3933

Submission Date October 15, 2025
Acceptance Date November 7, 2025
Publication Date January 6, 2026
Published in Issue Year 2026 Volume: 8 Issue: 1

Cite

AMA Karabuğa B, Yılmaz ME, Büyükkör M, et al. HALP and SII as blood-based predictors in metastatic small-cell lung cancer. Anatolian Curr Med J / ACMJ / acmj. January 2026;8(1):17-22. doi:10.38053/acmj.1797808

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