Prognostic utility of HALP score in predicting post-chemotherapy recurrence in testicular cancer: A retrospective cohort study

Abstract

Objective: The hemoglobin, albumin, lymphocyte, and platelet (HALP) score is an inflammation – and nutrition-based biomarker associated with prognosis in various malignancies. Its role in predicting post-chemotherapy recurrence in testicular germ cell tumors (TGCT) remains unclear. This study evaluated the prognostic value of the HALP score after cisplatin-based chemotherapy and its additional contribution beyond clinical staging. Patients and Methods: This retrospective cohort included 91 TGCT patients treated with orchiectomy and cisplatin-based chemotherapy between 2015 and 2023. Clinical, pathological, and hematologic data were collected. HALP, neutrophil-to-lymphocyte ratio (NLR), and systemic immune-inflammation index (SII) were calculated from pre-treatment laboratory values. Recurrence-free survival (RFS) was analyzed using Kaplan–Meier and Cox regression models. Receiver operating characteristic (ROC) analysis determined the optimal HALP cut-off. Results: Recurrence occurred in 14 patients (15.4%). Patients with recurrence had significantly lower baseline HALP scores. The optimal HALP cut-off was 53.615 (AUC=0.699). Higher HALP scores were associated with improved 3 – and 5-year RFS. HALP, NLR, SII, and advanced stage were significant in univariate analyses; however, only stage remained independently predictive in multivariate models. Conclusion: Lower pre-treatment HALP scores were associated with increased recurrence risk and inferior long-term RFS. HALP may provide complementary prognostic information within stage-defined groups.

Keywords

• Chemotherapy
• Germ cell tumor
• HALP score
• Recurrence
• Testicular cancer

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