Relationship Between Hemoglobin, Albumin, Lymphocyte and Platelet (HALP) Score and Geriatric Nutritional Risk Index (GNRI) and Prognosis in Patients Over 75 Years of Age with Metastatic Gastric Cancer

Yıl 2023, , 38 - 44, 28.04.2023

Serkan Menekşe , Engin Kut

https://doi.org/10.29058/mjwbs.1198056

Öz

Aim: Gastric cancer (GC) is a common cancer with high mortality. Stage is the most important predictor
of prognosis. But the clinical course of patients who are at the same stage may be different. Therefore,
other prognostic markers other than stage are needed. Hemoglobin, albumin, lymphocyte and platelet
(HALP) score and geriatric nutritional risk index (GNRI) related with prognosis in many malignancies,
but their relationship to prognosis in patients with GC with advanced age is unknown. For this reason,
we retrospectively analyzed patients older than 75 years, receiving chemotherapy, and metastatic GC.
Material and Methods: We retrospectively analyzed 145 patients with metastatic gastric cancer, older
than 75 years, receiving chemotherapy in secondary level state hospital between 2009 and 2022.
Patients’ gender, age, Eastern Cooperative Oncology Group (ECOG) performance score, diagnosis
dates, follow-up visits, albumin, hemoglobin, lactate dehydrogenase (LDH) levels, white blood cell,
neutrophil, lymphocyte and platelet count, weight (kg), height (cm) values were examined. Using these
values, HALP score, GNRI, and overall survival (OS) were calculated. Then, the relationship of these
parameters with OS was analyzed retrospectively.
Results: The median overall survival (OS) was 8.1 (95% Confidence interval (CI), 7.07 – 9.13) months.
In multivariate analysis, GNRI (0.035) and HALP (p<0.001) were associated with survival time. Median
OS was 4.5 (95% C,3.77-5.24 ) months in the low HALP group, and 10.2 (95% CI, 9.04- 11.36 ) months
in the high HALP group (p<0.001). Median OS was 6.2 (95% CI, 4.25-8.14) months in the low GNRI
group and 8.6 (95% CI, 7.92-9.27) months in the high GNRI group.
Conclusion: GNRI and HALP score are associated with survival in metastatic GC patients older than
75 years. GNRI and HALP score can be used as an easy, cheap and practical method for follow-up,
treatment and prognosis in elderly patients with metastatic GC.

Anahtar Kelimeler

Elderly gastric cancer, HALP score, GNRI, Geriatric nutritional risk index, prognosis

Destekleyen Kurum

yok (none)

Proje Numarası

yok (none)

Teşekkür

yok(none)

Yetmiş Beş Yaş Üstü Metastatik Mide Kanserli Hastalarda Hemoglobin, Albümin, Lenfosit, Platelet (HALP) Skoru ile Geriatrik Nütrisyonel İndeks (GNRI) ve Prognoz Arasındaki İlişki

Öz

Amaç: Mide kanseri (MK) sık görülen ve mortalitesi yüksek bir kanserdir. Evre, prognozun en önemli
belirleyicisidir. Ancak aynı evrede olan hastaların klinik seyri farklı olabilir. Bu nedenle evre dışında
başka prognostik belirteçlere ihtiyaç vardır. Hemoglobin, albümin, lenfosit ve trombosit (HALP) skoru ve geriatrik nütrisyonel risk indeksi (GNRI) birçok malignitede prognoz ile ilişkilidir, ancak ileri yaştaki mide kanserli hastalarda prognozla ilişkisi
bilinmemektedir. Bu nedenle metastatik, 75 yaş üstü, kemoterapi alan mide kanserli hastaları retrospektif olarak inceledik.
Gereç ve Yöntemler: İkinci basamak bir devlet hastanesinde 2009-2022 yılları arasında kemoterapi alan, 75 yaş üstü metastatik mide
kanserli 145 hasta retrospektif olarak incelendi. Hastaların cinsiyeti, yaşı, Eastern Cooperative Oncology Group (ECOG) performans skoru,
tanı tarihleri, kontrole geliş tarihleri, albümin seviyeleri, hemoglobin, laktat dehidrogenaz (LDH), beyaz küre sayısı, nötrofil, lenfosit ve
trombosit sayısı, ağırlık (kg), boy (cm) değerleri incelendi. Bu değerler kullanarak HALP skoru, GNRI, genel sağkalım (OS) hesaplandı.
ardından bu parametrelerin OS ile ilişkisi retrospektif olarak analiz edildi.
Bulgular: Medyan genel sağkalım (OS) 8.1 (%95 Güven aralığı (GA), 7.07 – 9.13) aydı. Çok değişkenli analizde, GNRI (0.035) ve HALP
skoru (p<0.001) sağkalım süresi ile ilişkiliydi. Medyan OS, düşük HALP grubunda 4,5 (%95 C,3.77-5.24 ) ay ve yüksek HALP grubunda 10.2
(%95 CI, 9.04- 11.36 ) ay saptandı (p<0.001). Medyan OS, düşük GNRI grubunda 6.2 (%95 GA, 4.25-8.14) ay ve yüksek GNRI grubunda
8.6 (%95 GA, 7.92-9.27) ay saptandı.
Sonuç: GNRI ve HALP skoru, 75 yaş üstü metastatik, mide kanserli hastalarda sağkalım süresi ile ilişkilidir. Metastatik mide kanserli yaşlı
hastalarda takip stratejisi geliştirmek, tedavi planlamak ve prognoz belirlemek için kolay, ucuz ve pratik bir yöntem olarak kullanılabilir

Anahtar Kelimeler

GNRI, Yaşlı mide kanseri, HALP skoru, GNRI, Geriatrik nutrisyonel risk indeksi, prognoz

Proje Numarası

yok (none)

Kaynakça

• 1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin 2021;71(3):209-249.
• 2. Öztürk ENY, Uyar M. Globocan 2012 ve 2018 verılerı üzerinden Dünya’da, Avrupa’da ve Türkiye’de en sık görülen beş kanser türünün değerlendirilmesi (Evaluatıon of the fıve most common types of cancer ın the World, Europe and Turkey vıa globocan 2012 and 2018 data). SAUHSD 2021;4(1):17-27.
• 3. Wong MCS, Huang J, Chan PSF, Choi P, Lao XQ, Chan SM, Teoh A, Liang P. Global incidence and mortality of gastric cancer, 1980-2018. JAMA Netw Open 2021;4(7):e2118457.
• 4. Elliot A, Myllymäki H, Feng Y. Inflammatory responses during tumour initiation: From Zebrafish transgenic models of cancer to evidence from Mouse and Man. Cells 2020;9:1018.
• 5. Borsig L, Wolf MJ, Roblek M, Lorentzen A, Heikenwalder M. Inflammatory chemokines and metastasis--Tracing the accessory. Oncogene 2014;33:3217-3224.
• 6. Coussens LM, Werb Z. Inflammation and cancer. Nature 2002;420:860-867.
• 7. McMillan DC. Systemic inflammation, nutritional status and survival in patients with cancer. Curr Opin Clin Nutr Metab Care 2009;12:223-226.
• 8. Fearon K, Strasser F, Anker SD, Bosaeus I, Bruera E, Fainsinger RL, Jatoi A, Loprinzi C, MacDonald N, Mantovani G, Davis M, Muscaritoli M, Ottery F, Radbruch L, Ravasco P, Walsh D, Wilcock A, Kaasa S, Baracos VE. Definition and classification of cancer cachexia: An international consensus. Lancet Oncol 2011;12:489-495.
• 9. Zitvogel L, Pietrocola F, Kroemer G. Nutrition, inflammation and cancer. Nat Immunol 2017;18(8):843-850.
• 10. Gupta D, Lis CG. Pretreatment serum albumin as a predictor of cancer survival: A systematic review of the epidemiological literature. Nutr J 2010;9:69.
• 11. Palacios-Acedo AL, Mège D, Crescence L, Dignat-George F, Dubois C, Panicot-Dubois L. Platelets, thrombo-inflammation, and cancer: Collaborating with the enemy. Front Immunol 2019;10:1805.
• 12. Zhao J, Huang W, Wu Y, Luo Y, Wu B, Cheng J, Chen J, Liu D, Li C. Prognostic role of pretreatment blood lymphocyte count in patients with solid tumors: A systematic review and metaanalysis. Cancer Cell Int 2020;20:15.
• 13. Jun JC, Rathore A, Younas H, Gilkes D, Polotsky VY. Hypoxiainducible factors and cancer. Curr Sleep Med Rep 2017;3(1):1- 10.
• 14. Marseglia L, Manti S, D’Angelo G, Nicotera A, Parisi E, Di Rosa G, Gitto E, Arrigo T. Oxidative stress in obesity: A critical component in human diseases. Int J Mol Sci 2014;16(1):378- 400.
• 15. Guo Y, Shi D, Zhang J, Mao S, Wang L, Zhang W, Zhang Z, Jin L, Yang B, Ye L, Yao X. 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.
• 16. Yalav O, Topal U, Ünal AG, Sarıtaş. Clinical value of hemoglobin and albumin levels and lymphocyte and platelet count (HALP) combination in predicting postoperative complications, lymph node positivity and prognosis in gastric cancer patients who underwent curative surgical resection. Markers 2020;4:9.
• 17. Chen XL, Xue L, Wang W, Chen HN, Zhang WH, Liu K, Chen XZ, Yang K, Zhang B, Chen ZX, Chen JP, Zhou ZG, Hu JK. Prognostic significance of the combination of preoperative hemoglobin, albumin, lymphocyte and platelet in patients with gastric carcinoma: A retrospective cohort study. Oncotarget 2015;6(38):41370-41382.
• 18. Jiang H, Li H, Li A, Tang E, Xu D, Chen Y, Zhang Y, Tang M, Zhang Z, Deng X, Lin M. Preoperative combined hemoglobin, albumin, lymphocyte and platelet levels predict survival in patients with locally advanced colorectal cancer. Oncotarget 2016; 7(44):72076-72083.
• 19. Peng D, Zhang CJ, Gong YQ, Hao H, Guan B, Li XS, Zhou LQ. Prognostic significance of HALP (hemoglobin, albumin, lymphocyte and platelet) in patients with bladder cancer after radical cystectomy, Sci Rep 2018;8(1):794.
• 20. Komura K, Hashimoto T, Tsujino T, Muraoka R, Tsutsumi T, Satake N, Matsunaga T, Yoshikawa Y, Takai T, Minami K, Taniguchi K, Uehara H, Tanaka T, Hirano H, Nomi H, Ibuki N, Takahara K, Inamoto T, Ohno Y, Azuma H. The CANLPH score, an integrative model of systemic inflammation and nutrition status (SINS), predicts clinical outcomes after surgery in renal cell carcinoma: Data from a multicenter cohort in Japan. Ann Surg Oncol 2019;26(9):2994-3004.
• 21. Xu SS, Li S, Xu HX, Li H, Wu CT, Wang WQ, Gao HL, Jiang W, Zhang WH, Li TJ, Ni QX, Liu L, Yu XJ. Haemoglobin, albumin, lymphocyte and platelet predicts postoperative survival in pancreatic cancer. World J Gastroenterol 2020;26(8):828-838.
• 22. Topal U, Dal F, Sözüer EM, Akyüz M,Talih T, İslam DG, Akyildiz HY. Combination of preoperative haemoglobin and albumin levels and lymphocyte and platelet counts (HALP) in patients with oesophageal cancer. J Evolution Med Dent Sci 2021;10(4):173-178.
• 23. Yang N, Han X, Yu J, Shu W, Qiu F, Han J. Hemoglobin, albumin, lymphocyte, and platelet score and neutrophil-tolymphocyte ratio are novel significant prognostic factors for patients with small-cell lung cancer undergoing chemotherapy. J Cancer Res Ther 2020;16(5):1134-1139.
• 24. Bouillanne O, Morineau G, Dupont C, Coulombel I, Vincent JP, Nicolis I, Benazeth S, Cynober L, Aussel C. Geriatric nutritional risk index: A new index for evaluating at-risk older medical patients. Am J Clin Nutr 2005;82(4):777-783.