HALP score as an independent prognostic biomarker for recurrence and progression in non–muscle-invasive bladder cancer: A retrospective cohort study

Abstract

Objective

This study aimed to evaluate the prognostic utility of the HALP (Hemoglobin-Albumin-Lymphocyte-Platelet) score in predicting tumor recurrence in patients with non-metastatic bladder cancer (NMIBC) without muscle invasion.

Methods

A retrospective cohort analysis was conducted involving 428 NMIBC patients followed for at least five years. HALP scores were calculated using preoperative hemoglobin, albumin, lymphocyte, and platelet measurements. Tumor recurrence was defined as the appearance of new lesions during follow-up, while muscle invasion was classified as progression. Determinants of recurrence were investigated using multivariate logistic regression and Cox proportional hazards models. The discriminative performance of the HALP score was evaluated using ROC analysis, and recurrence-free survival was compared according to the median HALP threshold using Kaplan-Meier methodology.

Results

The mean HALP score was significantly higher in patients without recurrence compared to those with recurrence (5.9 ± 1.3 vs. 4.6 ± 1.4; p < 0.001). HALP score, along with tumor size and grade, remained an independent predictor of recurrence in multivariate analyses (HR ≈ 0.825; p < 0.001). ROC analysis showed acceptable discrimination, and Kaplan-Meier curves showed significantly shorter recurrence-free survival in patients with lower HALP scores (log-rank p < 0.005). Additionally, HALP values were significantly lower in patients with progression compared to those without (p = 0.006).

Conclusion

HALP score is a simple, cost-effective biomarker reflecting immune nutrition status and is significantly associated with recurrence and progression in NMIBC. Inclusion of HALP in risk stratification models can improve individualized follow-up strategies and clinical decision-making processes in patients with non-invasive bladder cancer.

Structured abstract

Recurrence and progression remain major clinical challenges in non–muscle-invasive bladder cancer (NMIBC), highlighting the need for reliable and cost-effective prognostic biomarkers. This retrospective cohort study included 428 patients with NMIBC who were followed for at least five years to evaluate the prognostic value of the hemoglobin–albumin–lymphocyte–platelet (HALP) score. The HALP score was calculated using preoperative laboratory parameters, and recurrence and progression were analyzed using multivariable logistic regression, Cox proportional hazards models, receiver operating characteristic analysis, and Kaplan–Meier survival analysis. Patients with recurrence exhibited significantly lower HALP scores compared with those without recurrence, and the HALP score remained an independent predictor of recurrence in multivariable analyses (HR ≈ 0.83; p < 0.001). ROC analysis demonstrated acceptable discriminatory performance (AUC = 0.78), while Kaplan–Meier analysis showed significantly shorter recurrence-free survival in patients with low HALP scores. Additionally, HALP values were significantly lower in patients who developed disease progression. These findings suggest that the HALP score is a simple, inexpensive, and independent prognostic biomarker that may enhance risk stratification and support personalized surveillance strategies in patients with NMIBC.