Preoperative HALP Profiles in Serous and Mucinous Epithelial Ovarian Tumors: Positioning Borderline Tumors on the Benign-Malignant Spectrum.

Abstract

Background/Objectives: Borderline ovarian tumors can overlap with benign and malignant adnexal masses in their preoperative features. The hemoglobin-albumin-lymphocyte-platelet (HALP) score reflects inflammatory and immunonutritional status. We compared HALP profiles across benign, borderline, and malignant epithelial ovarian tumors and secondarily explored their contribution beyond the risk of malignancy index (RMI). Methods: This retrospective single-center study included 464 women treated surgically for serous or mucinous epithelial ovarian tumors between 2015 and 2025: 164 benign cystadenomas, 78 borderline tumors, and 222 invasive carcinomas. HALP was compared among groups with additional adjustment for age and menopausal status. Regression and model-performance analyses were performed only in the borderline and malignant groups (n = 300). Results: Median HALP was lower in malignant tumors [28.6 (IQR 22.4)] than in benign [38.3 (23.8)] and borderline tumors [40.5 (21.4)] (both p < 0.001), whereas benign and borderline tumors were similar (p = 0.948). After adjustment, HALP remained lower in malignant tumors than in benign (adjusted median difference, -10.49; 95% CI, -15.47 to -4.55) and borderline tumors (-11.86; 95% CI, -18.63 to -5.84). In exploratory malignant-versus-borderline modeling, HALP was associated with malignant histology alone, but this association was attenuated after accounting for age and log-transformed RMI; adding HALP did not significantly improve model fit or discrimination. Conclusions: Preoperative HALP was consistently lower in malignant tumors, while borderline tumors resembled benign lesions. HALP may reflect systemic immunonutritional differences across pathological groups. Its incremental predictive role beyond established preoperative measures remains uncertain and requires external validation.