Analysis of correlation between HALP and pathological features of colon cancer and its effect on liver metastasis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

YANG Limin ,  KUI Guoju

Department of Pathology, The 909th Hospital of Joint Logistic Support Forces (Dongnan Hospital of Xiamen University), Zhangzhou, Fujian 363000, P. R. China;

Corresponding author：

KUI Guoju, Email: kuiguoju_2005@163.com

Keywords：

hemoglobin; albumin; lymphocyte; platelets; colon cancer; liver metastasis; predictive value

DOI：

10.7507/1007-9424.202303033

Video：

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Objective To investigate the relationship between preoperative hemoglobin, albumin, lymphocyte and platelet (HALP) score, and clinicopathologic features of colon cancer, and to analyze the predictive value of HALP score for postoperative liver metastasis. Methods The clinical data of 163 patients with colon cancer admitted to the 909th Hospital of Joint Logistic Support Force (Dongnan Hospital of Xiamen University) from January 2018 to December 2019 were retrospectively analyzed. According to the occurrence of postoperative liver metastasis, the patients were divided into metastatic group (n=35) and non-metastatic group (n=128). The correlation between preoperative HAPL score and clinicopathologic features of colon cancer was analyzed. The predictive value of HALP score for postoperative liver metastasis of colon cancer was analyzed by using receiver operating characteristic (ROC) curve. The risk factors of liver metastasis after colon cancer surgery were analyzed by using univariate and multivariate logistic analysis. Kaplan-Meier risk curve was drawn, and log-rank test was used to analyze the predictive value of different HALP score for postoperative liver metastasis. Results HALP score were decreased in patients with maximum tumor diameter ≥5 cm, preoperative carcinoembryonic antigen (CEA) ≥5 μg/L, serous membrane and extrasserous infiltration, lymph node metastasis and vascular invasion, and the difference was statistically significant (P<0.05). Multivariate logistic regression analysis showed that HALP score [OR=1.467, 95%CI (1.253, 1.718), P<0.001], maximum tumor diameter [OR=3.476, 95%CI (1.475, 5.358), P=0.013], preoperative CEA level [OR= 6.197, 95%CI (2.436, 6.248), P=0.005], and lymph node metastasis [OR=2.593, 95%CI (1.667, 6.759) , P=0.003] were risk factors for postoperative liver metastasis of colon cancer. ROC curve analysis showed that the area under the curve of HALP score for predicting liver metastasis after colon cancer surgery was 0.908 (0.841, 0.974), the maximum value of the Youden index was 0.738, the optimal cut-off value of the HALP score was 35.5, the sensitivity was 0.852, the specificity was 0.886. Kaplan-Meier risk curve showed that the risk of early postoperative liver metastasis in the low HALP score group was higher than that in the high HALP score group (χ²=8.126, P=0.004). Conclusion Low HALP score in patients with colon cancer is associated with adverse prognosisi related pathological features, and is an influential factor for postoperative liver metastasis of colon cancer, and has predictive value for patients with postoperative liver metastasis of colon cancer.

Citation： YANG Limin, KUI Guoju. Analysis of correlation between HALP and pathological features of colon cancer and its effect on liver metastasis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2023, 30(8): 958-963. doi: 10.7507/1007-9424.202303033 Copy

1.	Global Burden of Disease Cancer Collaboration, Fitzmaurice C, Abate D, et al. Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 29 cancer groups, 1990 to 2017: a systematic analysis for the Global Burden of Disease Study. JAMA Oncol, 2019, 5(12): 1749-1768.
2.	程晨, 吴云桦, 徐正水, 等. Ⅱ~Ⅲ期结肠癌根治术后复发危险因素分析及其列线图预测模型的应用价值. 中华消化外科杂志, 2021, 20(3): 331-338.
3.	段丽宁, 常宁, 赵亚静, 等. 血清肿瘤标志物联合肝功能指标检测对结肠癌肝转移的诊断价值. 中华肿瘤防治杂志, 2022, 29(16): 1206-1210.
4.	Giannis D, Sideris G, Kakos CD, et al. The role of liver transplantation for colorectal liver metastases: a systematic review and pooled analysis. Transplant Rev (Orlando), 2022, 34(4): 100570. doi: 10.1016/j.trre.2020.100570.
5.	Wang X, He Q, Liang H, et al. A novel robust nomogram based on preoperative hemoglobin and albumin levels and lymphocyte and platelet counts (HALP) for predicting lymph node metastasis of gastric cancer. J Gastrointest Oncol, 2021, 12(6): 2706-2718.
6.	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.
7.	Wei S, Shao J, Wang J, et al. The preoperative hemoglobin, albumin, lymphocyte, and platelet score is a prognostic factor for non-small cell lung cancer patients undergoing adjuvant chemotherapy: a retrospective study. Ann Transl Med, 2022, 10(8): 457. doi: 10.21037/atm-22-1097.
8.	Polk N, Budai B, Hitre E, et al. Corrigendum: high neutrophil-to-lymphocyte ratio (NLR) and systemic immune-inflammation index (SII) are markers of longer survival after metastasectomy of patients with liver-only metastasis of rectal cancer. Pathol Oncol Res, 2022, 28: 1610658. doi: 10.3389/pore.2022.1610658.
9.	赵伽木, 张伟, 周洪渊, 等. 结直肠癌肝转移的最新研究进展. 中华肝脏外科杂志, 2021, 2(27): 156-160.
10.	俞甲子, 张明元, 金梁斌, 等. 结直肠癌不同部位的原发灶对肝转移瘤根治切除术后早期复发的影响. 中华普通外科杂志, 2022, 37(6): 434-438.
11.	Zhang L, Qiao L, Zhang M, et al. Comparison of prognosis among patients with colorectal cancer liver metastases treated by surgical resection, radiofrequency ablation and HIFU: a protocol for network meta-analysis. Medicine (Baltimore), 2022, 101(33): e27915. doi: 10.1097/MD.0000000000027915.
12.	Zhang L, Zhang Z, Guo H, et al. Systemic immune-inflammation index: a new indicator of predicting 1-, 2-and 3-year disease-free survival of patients with colon cancer. Adv Clin Exp Med, 2022, 32(1): 13-22.
13.	Belcher DA, Lucas A, Cabrales P, et al. Polymerized human hemoglobin facilitated modulation of tumor oxygenation is dependent on tumor oxygenation status and oxygen affinity of the hemoglobin-based oxygen carrier. Sci Rep, 2020, 10(1): 11372. doi: 10.1038/s41598-020-68190-0.
14.	Cheong CM, Golder AM, Horgan PG, et al. Relationship between pre-operative glycated haemoglobin and surgical site infection in patients undergoing elective colon cancer surgery. Oncol Lett, 2022, 24(3): 296. doi: 10.3892/ol.2022.13416.
15.	Xie H, Wei L, Liu M, et al. Neutrophil-albumin ratio as a biomarker for postoperative complications and long-term prognosis in patients with colorectal cancer undergoing surgical treatment. Front Nutr, 2022, 15(9): 976216. doi: 10.3389/fnut.2022.976216.
16.	袁梦依, 王培山, 孟瑞霞, 等. 术前 HALP 评分对老年非小细胞肺癌手术病人预后的预测价值. 实用老年医学, 2022, 12(36): 1259-1263.
17.	Hajibandeh S, Barghash M, Khan RMA, et al. Predictive significance of tumour size in patients undergoing curative surgery for colorectal cancer: a retrospective cohort study. Cureus, 2022, 14(7): e26656. doi: 10.7759/cureus.26656.
18.	Aylward C, Noori J, Tyrrell J, et al. Survival outcomes after synchronous para-aortic lymph node metastasis in colorectal cancer: a systematic review. J Surg Oncol, 2023, 127(4): 645-656.
19.	段晶晶, 邓婷, 巴一. 传统肿瘤标志物在结直肠癌中的应用现状. 肿瘤综合治疗电子杂志, 2020, 6(2): 1-6.
20.	刘庆睿, 姜宪. 结肠癌肝转移患者临床特征及预后危险因素分析: 基于 SEER 数据库. 消化肿瘤杂志(电子版), 2022, 1(14): 65-70.
21.	Zhao J, Zhu J, Huang C, et al. Impact of primary tumor resection on the survival of patients with unresectable colon cancer liver metastasis at different colonic subsites: a propensity score matching analysis. Acta Chir Belg, 2023, 123(2): 132-147.
22.	Russolillo N, Sperti E, Langella S, et al. Impact of primary tumor location on patterns of recurrence and survival of patients undergoing resection of liver metastases from colon cancer. HPB (Oxford), 2020, 22(1): 116-123.
23.	Hayama T, Ozawa T, Asako K, et al. Impact of colon cancer location on the prognostic significance of nutritional indexes and inflammatory markers. In vivo, 2021, 35(2): 1261-1269.
24.	Mazaki J, Katsumata K, Sujino H, et al. Neutrophil-to-lymphocyte ratio as a prognostic factor for colon cancer in elderly patients: a propensity score analysis. Anticancer Res, 2021, 41(9): 4471-4478.
25.	Xu SS, Li S, Xu HX, et al. Haemoglobin, albumin, lymphocyte and platelet predicts postoperative survival in pancreatic cancer. World J Gastroenterol, 2020, 26(8): 828-838.
26.	Guo Y, Shi D, Zhang J, et al. 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): 81-91.
27.	张利, 彭丽丽, 孙宁宁, 等. 治疗前HALP评分对Ⅳ期无驱动基因NSCLC患者的预后意义. 现代肿瘤医学, 2022, 18(30): 3310-3315.

1. Global Burden of Disease Cancer Collaboration, Fitzmaurice C, Abate D, et al. Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 29 cancer groups, 1990 to 2017: a systematic analysis for the Global Burden of Disease Study. JAMA Oncol, 2019, 5(12): 1749-1768.
2. 程晨, 吴云桦, 徐正水, 等. Ⅱ~Ⅲ期结肠癌根治术后复发危险因素分析及其列线图预测模型的应用价值. 中华消化外科杂志, 2021, 20(3): 331-338.
3. 段丽宁, 常宁, 赵亚静, 等. 血清肿瘤标志物联合肝功能指标检测对结肠癌肝转移的诊断价值. 中华肿瘤防治杂志, 2022, 29(16): 1206-1210.
4. Giannis D, Sideris G, Kakos CD, et al. The role of liver transplantation for colorectal liver metastases: a systematic review and pooled analysis. Transplant Rev (Orlando), 2022, 34(4): 100570. doi: 10.1016/j.trre.2020.100570.
5. Wang X, He Q, Liang H, et al. A novel robust nomogram based on preoperative hemoglobin and albumin levels and lymphocyte and platelet counts (HALP) for predicting lymph node metastasis of gastric cancer. J Gastrointest Oncol, 2021, 12(6): 2706-2718.
6. 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.
7. Wei S, Shao J, Wang J, et al. The preoperative hemoglobin, albumin, lymphocyte, and platelet score is a prognostic factor for non-small cell lung cancer patients undergoing adjuvant chemotherapy: a retrospective study. Ann Transl Med, 2022, 10(8): 457. doi: 10.21037/atm-22-1097.
8. Polk N, Budai B, Hitre E, et al. Corrigendum: high neutrophil-to-lymphocyte ratio (NLR) and systemic immune-inflammation index (SII) are markers of longer survival after metastasectomy of patients with liver-only metastasis of rectal cancer. Pathol Oncol Res, 2022, 28: 1610658. doi: 10.3389/pore.2022.1610658.
9. 赵伽木, 张伟, 周洪渊, 等. 结直肠癌肝转移的最新研究进展. 中华肝脏外科杂志, 2021, 2(27): 156-160.
10. 俞甲子, 张明元, 金梁斌, 等. 结直肠癌不同部位的原发灶对肝转移瘤根治切除术后早期复发的影响. 中华普通外科杂志, 2022, 37(6): 434-438.
11. Zhang L, Qiao L, Zhang M, et al. Comparison of prognosis among patients with colorectal cancer liver metastases treated by surgical resection, radiofrequency ablation and HIFU: a protocol for network meta-analysis. Medicine (Baltimore), 2022, 101(33): e27915. doi: 10.1097/MD.0000000000027915.
12. Zhang L, Zhang Z, Guo H, et al. Systemic immune-inflammation index: a new indicator of predicting 1-, 2-and 3-year disease-free survival of patients with colon cancer. Adv Clin Exp Med, 2022, 32(1): 13-22.
13. Belcher DA, Lucas A, Cabrales P, et al. Polymerized human hemoglobin facilitated modulation of tumor oxygenation is dependent on tumor oxygenation status and oxygen affinity of the hemoglobin-based oxygen carrier. Sci Rep, 2020, 10(1): 11372. doi: 10.1038/s41598-020-68190-0.
14. Cheong CM, Golder AM, Horgan PG, et al. Relationship between pre-operative glycated haemoglobin and surgical site infection in patients undergoing elective colon cancer surgery. Oncol Lett, 2022, 24(3): 296. doi: 10.3892/ol.2022.13416.
15. Xie H, Wei L, Liu M, et al. Neutrophil-albumin ratio as a biomarker for postoperative complications and long-term prognosis in patients with colorectal cancer undergoing surgical treatment. Front Nutr, 2022, 15(9): 976216. doi: 10.3389/fnut.2022.976216.
16. 袁梦依, 王培山, 孟瑞霞, 等. 术前 HALP 评分对老年非小细胞肺癌手术病人预后的预测价值. 实用老年医学, 2022, 12(36): 1259-1263.
17. Hajibandeh S, Barghash M, Khan RMA, et al. Predictive significance of tumour size in patients undergoing curative surgery for colorectal cancer: a retrospective cohort study. Cureus, 2022, 14(7): e26656. doi: 10.7759/cureus.26656.
18. Aylward C, Noori J, Tyrrell J, et al. Survival outcomes after synchronous para-aortic lymph node metastasis in colorectal cancer: a systematic review. J Surg Oncol, 2023, 127(4): 645-656.
19. 段晶晶, 邓婷, 巴一. 传统肿瘤标志物在结直肠癌中的应用现状. 肿瘤综合治疗电子杂志, 2020, 6(2): 1-6.
20. 刘庆睿, 姜宪. 结肠癌肝转移患者临床特征及预后危险因素分析: 基于 SEER 数据库. 消化肿瘤杂志(电子版), 2022, 1(14): 65-70.
21. Zhao J, Zhu J, Huang C, et al. Impact of primary tumor resection on the survival of patients with unresectable colon cancer liver metastasis at different colonic subsites: a propensity score matching analysis. Acta Chir Belg, 2023, 123(2): 132-147.
22. Russolillo N, Sperti E, Langella S, et al. Impact of primary tumor location on patterns of recurrence and survival of patients undergoing resection of liver metastases from colon cancer. HPB (Oxford), 2020, 22(1): 116-123.
23. Hayama T, Ozawa T, Asako K, et al. Impact of colon cancer location on the prognostic significance of nutritional indexes and inflammatory markers. In vivo, 2021, 35(2): 1261-1269.
24. Mazaki J, Katsumata K, Sujino H, et al. Neutrophil-to-lymphocyte ratio as a prognostic factor for colon cancer in elderly patients: a propensity score analysis. Anticancer Res, 2021, 41(9): 4471-4478.
25. Xu SS, Li S, Xu HX, et al. Haemoglobin, albumin, lymphocyte and platelet predicts postoperative survival in pancreatic cancer. World J Gastroenterol, 2020, 26(8): 828-838.
26. Guo Y, Shi D, Zhang J, et al. 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): 81-91.
27. 张利, 彭丽丽, 孙宁宁, 等. 治疗前HALP评分对Ⅳ期无驱动基因NSCLC患者的预后意义. 现代肿瘤医学, 2022, 18(30): 3310-3315.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Analysis of correlation between HALP and pathological features of colon cancer and its effect on liver metastasis

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