Predictive values of the hemoglobin, albumin, lymphocyte and platelet score (HALP) and the modified -Gustave Roussy immune score for esophageal squamous cell carcinoma patients undergoing concurrent chemoradiotherapy

CT Multidimensional Radiomics Combined with Inflammatory Immune Score For Preoperative Prediction of Pathological Grade in Esophageal Squamous Cell Carcinoma

RATIONALE AND OBJECTIVES

Inflammation and immune biomarkers can promote angiogenesis and proliferation and metastasis of esophageal squamous cell carcinoma (ESCC). The degree of pathological grade reflects the tumor heterogeneity of ESCC. The purpose is to develop and validate a nomogram based on enhanced CT multidimensional radiomics combined with inflammatory immune score (IIS) for predicting poorly differentiated ESCC.

MATERIALS AND METHODS

A total of 266 ESCC patients from the retrospective study were included and randomly divided into a training set (N=186) and a validation set (N=80), and a complete data set (N=266), and overall survival was determined to follow up after surgery. The tumor imaging was segmented to form intratumoral and peritumoral 3 mm areas of 3D volume of interest (VOI) on CT arterial and venous phases, and 3404 radiomics features were extracted. Finally, the radiomics scores were calculated for arterial phase intratumoral (aInRads), peritumoral 3 mm (aPeriRads3), and venous phase intratumoral (vInRads), peritumoral 3 mm (vPeriRads3). Logistic regression was used to fuse the four cohorts of scores to form a Stacking. Additionally, sixteen inflammatory-immune biomarkers were analyzed, including aspartate aminotransferase to lymphocyte ratio (ALRI), aspartate aminotransferase to alanine aminotransferase ratio (AAR), neutrophil times gamma-glutamyl transpeptidase to lymphocyte ratio (NγLR), and albumin plus 5 times lymphocyte sum (PNI), etc. Finally, IIS was constructed using ALRI, AAR, NγLR and PNI. Model performance was evaluated by area under receiver operating characteristic curve (AUC), calibration curve, and decision curve analyse (DCA).

RESULTS

Stacking and IIS were independent risk factors for predicting poorly differentiated ESCC (P<0.05). Ultimately, three models of the IIS, Stacking, and nomogram were developed. Compared with the Stacking and IIS models, nomogram achieved better diagnostic performance for predicting poorly differentiated ESCC in the training set (0.881vs 0.835 vs 0.750), validation set (0.808 vs 0.796 vs 0.595), and complete data set (0.857 vs 0.823 vs 0.703). The nomogram achieved an AUC of 0.881(95%CI 0.826-0.924) in the training set, and was well verified in the validation set (AUC: 0.808[95%CI 0.705-0.888]) and the complete data set (AUC: 0.857[95%CI 0.809-0.897]). Moreover, calibration curve and DCA showed that nomogram achieved good calibration and owned more clinical net benefits in the three cohorts. KaplanMeier survival curves indicated that nomogram achieved excellent stratification for ESCC grade status (P<0.0001).

CONCLUSION

The nomogram that integrates preoperative inflammatory-immune biomarkers, intratumoral and peritumoral CT radiomics achieves a high and stable diagnostic performance for predicting poorly differentiated ESCC, and may be promising for individualized surgical selection and management.

AVAILABILITY OF DATA AND MATERIALS

The original manuscript contained in the research is included in the article. Further inquiries can be made directly to the corresponding author.

Prognostic significance of hemoglobin, albumin, lymphocyte and platelet score in solid tumors: a pooled study

Objective

The high hemoglobin, albumin, lymphocyte, and platelet (HALP) score has been reported to be a good prognostic indicator for several malignancies. However, more evidence is needed before it can be introduced into clinical practice. Here, we systematically evaluated the predictive value of HALP for survival outcomes in patients with solid tumors.

Methods

This study was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Assessing the Methodological Quality of Systematic Reviews (AMSTAR) Guidelines. In March 2024, an electronic literature search was performed for articles regarding the prognostic role of HALP in solid tumors. Data from studies with reported risk ratios (HRs) and 95% confidence intervals (CIs) were pooled in a meta-analysis. Study bias was assessed using the QUIPS tool.

Results

Of the 729 articles reviewed, 45 cohorts including data from 17,049 patients with cancer were included in the pooled analysis. The pooled results demonstrated that elevated HALP score was significantly associated with favorable overall survival (HR = 0.60, 95% CI 0.54-0.67, p < 0.01), cancer-specific survival (HR = 0.53, 95% CI 0.44- 0.64, p < 0.01), progression-free survival (HR = 0.62, 95% CI 0.54-0.72, p < 0.01), recurrence-free survival (HR = 0.48, 95% CI 0.30-0.77, p < 0.01), and disease-free survival (HR = 0.72, 95% CI 0.57-0.82, p < 0.01). Subgroup analyses based on various confounding factors further revealed the consistent prognostic impact of HALP on overall survival in patients with solid tumors.

Conclusions

Our findings suggest that high HALP is associated with better survival outcomes in patients. The HALP score is a potential prognostic biomarker in solid tumors, but it needs to be further studied whether it can improve the established prognostic model.

Role of the hemoglobin, albumin, lymphocyte, and platelet score in predicting thrombophlebitis among patients undergoing peripherally inserted central catheter

This study analyzes the role of the hemoglobin, albumin, lymphocyte, and platelet score (HALP), a pre-catheterization blood parameter, in predicting the occurrence of thrombophlebitis. We recruited 268 in-hospital patients who visited the Department of Oncology of our hospital and underwent peripherally inserted central catheter between January 2021 and January 2024. The cutoff value of the HALP score was defined using receiver's operating characteristic curve, and the differences were analyzed with log-rank test. The significance of HALP in predicting thrombophlebitis was evaluated using a multivariate Cox proportional hazards model. A total of 240 patients were enrolled and divided into a high-HALP (≥31.4) group (n = 125) and a low-HALP (<31.4) group (n = 115). The relationship between the composition of HALP and clinical pathological parameters was analyzed. HALP was significantly correlated with gender (X2 = 4.74), limb restriction (X2 = 3.69), performance status score (X2 = 11.9), D-dimer (X2 = 7.88), and platelet count (X2 = 5.22). Multivariate regression analysis found male (hazard ratio [HR] 0.29 (0.12-0.69)), more puncture times (HR 0.01 (0.001-0.15)), lower HALP (HR 1.93 (0.82-4.52)), and sterile couplant (HR 20.6 (4.7-91.2)) were independent factors affecting the occurrence of thrombophlebitis. Receiver's operating characteristic curve analysis showed the area under the curve of the HALP score was 0.718 (95% confidence interval 0.638-0.798), which was significantly larger than the other 3 parameters. Hence, we believe the predictive efficiency of HALP is higher than other parameters. The pre-catheterization HALP score can be used as a simple, accessible, and reliable tool for predicting thrombophlebitis in patients to undergo peripherally inserted central catheter.

Efficacy, safety, and prognostic modeling in neoadjuvant immunotherapy for esophageal squamous cell carcinoma

OBJECTIVE

To evaluate the safety and efficacy of neoadjuvant immunotherapy in patients with esophageal squamous cell carcinoma (ESCC) and construct a prognostic model.

METHODS

Clinical data were retrospectively collected from patients with locally advanced ESCC who received neoadjuvant immunotherapy and chemotherapy. The primary endpoints were major pathologic remission rate and disease-free survival, and secondary endpoints were treatment-related adverse events and perioperative complications. Correlates affecting pathological response were analyzed using univariate and multivariate logistic regression, survival-related variables were screened by Boruta and least absolute shrinkage and selection operator Cox regression analysis. A nomogram was constructed and utilized to test the predictive efficacy of the treatment with receiver operating characteristic curve and decision curve analysis.

RESULTS

A total of 181 patients were enrolled, of whom 119 (66 %) patients received 3-4 cycles of treatment. Treatment-related adverse events occurred in 65.2 % of the patients, with 13.3 % experiencing severe complications. Major pathological remission rate was achieved in 68 (37.6 %) patients, with no significant difference between the treatment cycle groups (P=0.925). The nomogram included pathologic TNM stage, lymphovascular invasion, post-treatment and post-surgery albumin levels, and post-treatment systemic immune-inflammation index. One-year disease-free survival area under the curve was 0.86 (95 %CI, 0.75-0.97) in the derivation cohort and 0.75 (95 %CI, 0.50-0.99) in the validation cohort, with good calibration performance.

CONCLUSIONS

Pathological staging combined with albumin level and systemic immune-inflammation index could be a superior predictor of survival prognosis in ESCC patients receiving neoadjuvant immunotherapy. The findings of this study yield new evidence regarding the efficacy and safety of neoadjuvant immunotherapy in ESCC and provide a tool for identifying patients at risk of recurrence.

A novel high-risk model identified by epithelial-mesenchymal transition predicts prognosis and radioresistance in rectal cancer

Many studies have shown that tumor cells that survive radiotherapy are more likely to metastasize, but the underlying mechanism remains unclear. Here we aimed to identify epithelial-mesenchymal transition (EMT)-related key genes, which associated with prognosis and radiosensitivity in rectal cancer. First, we obtained differentially expressed genes by analyzing the RNA expression profiles of rectal cancer retrieved from The Cancer Genome Atlas database, EMT-related genes, and radiotherapy-related databases, respectively. Then, Lasso and Cox regression analyses were used to establish an EMT-related prognosis model (EMTPM) based on the identified independent protective factor Fibulin5 (FBLN5) and independent risk gene EHMT2. The high-EMTPM group exhibited significantly poorer prognosis. Then, we evaluated the signature in an external clinical validation cohort. Through in vivo experiments, we further demonstrated that EMTPM effectively distinguishes radioresistant from radiosensitive patients with rectal cancer. Moreover, individuals in the high-EMTPM group showed increased expression of immune checkpoints compared to their counterparts. Finally, pan-cancer analysis of the EMTPM model also indicated its potential for predicting the prognosis of lung squamous cell carcinoma and breast cancer patients undergoing radiotherapy. In summary, we established a novel predictive model for rectal cancer prognosis and radioresistance based on FBLN5 and EHMT2 expressions, and suggested that immune microenvironment may be involved in the process of radioresistance. This predictive model could be used to select management strategies for rectal cancer.

Exploring the J-shaped relationship between HALP score and mortality in cancer patients: A NHANES 1999-2018 cohort study

Background

The recent hemoglobin, albumin, lymphocyte, and platelet (HALP) scores, combined with various clinically available indicators, can comprehensively evaluate the nutritional and immune status of patients. Some observational studies have found a positive correlation between HALP score and cancer prognosis, but the clinical application of HALP score has raised concerns due to the presence of confounding factors. The aim of this study is to explore the relationship between HALP score and long-term mortality in cancer patients.

Methods

We extracted 3832 cancer patients with complete baseline information from the National Health and Nutrition Examination Survey (NHANES). The COX regressions and restricted cubic spline (RCS) curves were used to explore the nonlinear relationship between HALP score and long-term mortality risk in cancer patients. Kaplan-Meier (K-M) curve was conducted to evaluate the impact of HALP score on long-term mortality risk. Additionally, subgroup analysis was conducted to verify the stability of the above results.

Results

We divided participants into 4 groups based on HALP score, and the COX regression results showed that risk of long-term mortality tended to be lower in cancer patients with high HALP scores. Meanwhile, the RCS curves showed that there was a nonlinear association. The results remained stable in subgroup analyses and in breast cancer, colorectal cancer, cervix and uterus cancer, melanoma, prostate cancer and skin cancer.

Conclusions

HALP score were independently associated with the risk of long-term mortality in cancer patients, and there is also a non-linear association. This will provide new perspectives on clinical and nutritional interventions for cancer patients.

Fasting Blood Glucose-Based Novel Predictors in Detecting Metastases and Predicting Prognosis for Patients with PNENs

OBJECTIVE

To explore three novel fasting blood glucose (FBG)-based novel indicators, including the FBG-to-albumin ratio (FAR), FBG-to-lymphocytes ratio (FLR), and FBG-to-hemoglobin ratio (FHR), in predicting prognosis and detecting metastasis for patients with pancreatic neuroendocrine neoplasms (pNENs) after resection.

MATERIALS AND METHODS

A total of 178 pNENs patients who underwent surgical resection were included in this study. Receiver operating characteristic (ROC) curves were used to evaluate the diagnosis values of FAR, FLR, and FHR, and the cutoff values were obtained for further analyses. Univariate and multivariate analyses were conducted to determine the independent predictors. The Kaplan-Meier method was used to evaluate the progression-free survival (PFS) and overall survival (OS) of the pNENs patients.

RESULTS

The optimal cutoff values of FAR, FLR, and FHR were 0.17, 2.85, and 0.028, respectively. As for PFS, the area under the curve (AUC) was 0.693 for FAR, 0.690 for FLR, and 0.661 for FHR, respectively. The AUC was 0.770, 0.692, and 0.715 accordingly for OS. The groups with lower FAR, FLR, and FHR were significantly associated with prolonged PFS and OS (p < 0.05). In patients with metastasis, the lower FAR group was correlated with significantly longer PFS and OS (p = 0.022 and 0.002, respectively). The FLR was an independent predictor of PFS in pNENs patients, and the FAR was a predictor of OS. FAR was an independent indicator of PFS in patients with metastasis.

CONCLUSIONS

Preoperative FAR, FLR, and FHR are effective in predicting the prognosis of pNEN patients and detecting the synchronous metastases.

Prognostic significance of hemoglobin, albumin, lymphocyte, and platelet (HALP) score in breast cancer: a propensity score-matching study

BACKGROUND

The hemoglobin-albumin-lymphocyte-platelet (HALP) score functions as a comprehensive index that assesses the systemic inflammatory response, nutritional, and immune status. This study aimed to explore the relationship between preoperative HALP score and the prognosis of BC patients and to develop predictive nomograms.

METHODS

Clinicopathological data were collected for BC patients who underwent mastectomy between December 2010 and April 2014 from Sun Yat-sen University Cancer Center. The optimal cutoff value for HALP was determined by maximally selected rank statistics for overall survival data. Propensity score matching (PSM) was applied to develop comparable cohorts of high-HALP group and low-HALP group. Kaplan-Meier curves and Cox regression analyses were performed to determine the impact of HALP on BC patients. Prognostic nomograms were developed based on the multivariate Cox regression method. Then, the concordance index (C-index), calibration plots, and decision curves analysis (DCA) were applied to evaluate the prognostic performance of the nomograms.

RESULTS

A total of 1,856 patients were included as the primary cohort, and 1,470 patients were matched and considered as the PSM cohort. In the primary cohort, the 5-year overall survival (OS) and progression-free survival (PFS) rates for high-HALP group (≥ 47.89) and low-HALP group (< 47.89) were 94.4% vs. 91.0% (P = 0.005) and 87.8% vs. 82.1% (P = 0.005), respectively. Similar results were observed in PSM cohort (5-year OS, 94.3% vs. 90.8%, P = 0.015; 5-year PFS, 87.5% vs. 83.2%, P = 0.036). Notably, multivariate Cox regression analysis in the PSM cohort showed that HALP could independently predict BC patient prognosis in both OS (HR: 0.596, 95%CI [0.405-0.875], P = 0.008) and PFS (HR: 0.707, 95%CI [0.538-0.930], P = 0.013). OS and PFS nomograms showed excellent predictive performance with the C-indexes of 0.783 and 0.720, respectively. The calibration plots and DCA also indicated the good predictability of the nomograms. Finally, subgroup analysis further demonstrated a favorable impact of HALP on both OS and PFS.

CONCLUSION

Preoperative HALP score can be used as a reliable independent predictor of OS and PFS in BC patients, and the nomograms may provide a personalized treatment strategy.

Prognostic Value of the Gustave Roussy Immune Score in Lung Cancer: A Meta-Analysis

PURPOSE

To clarify the prognostic role of the Gustave Roussy immune (GRIm) score in lung cancer.

METHODS

The PubMed, Embase, Web of Science, and China National Knowledge Infrastructure databases were searched up to March 30, 2024. The primary outcomes included overall survival (OS) and progression-free survival (PFS). Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated to evaluate the associations between the GRIm score and survival, and subgroup analyses were performed based on pathological type (non-small cell lung cancer vs. small cell lung cancer), tumor stage (advanced vs. limited stage) and treatment approach (immune checkpoint inhibitor vs. surgery vs. chemotherapy).

RESULTS

Eight studies with 1,333 participants were included. The pooled results showed that a higher GRIm score predicted worse OS (HR = 1.96, 95% CI: 1.54-2.49, P < 0.001) and PFS (HR = 1.64, 95% CI: 1.22-2.21, P = 0.001). Subgroup analyses for OS and PFS showed similar results. However, subgroup analyses for PFS indicated that the association between the GRIm score and PFS was nonsignificant among patients with small cell lung cancer (P = 0.114) and among patients treated with chemotherapy (P = 0.276).

CONCLUSION

The GRIm score might serve as a novel prognostic factor for lung cancer. Additional studies are still needed to verify these findings.

Prognosis of patients with advanced bile tract carcinoma: assessment using the modified-Gustave Roussy Immune Score (mGRIm-s) as a clinico-immunological tool

BACKGROUND

The emergence of immune checkpoint inhibitors (ICIs) has enhanced survival outcomes for certain patients with advanced biliary tract carcinoma (BTC). Pinpointing those who would benefit most from immunotherapy remains elusive. We investigated the predictive value of the modified Gustave Roussy Immune Score (mGRIm-s) in BTC patients treated with ICIs.

METHODS

Data from 110 patients at Chinese People's Liberation Army General Hospital, spanning September 2015 to April 2021, were analyzed. The median follow-up duration was 38.7 months as of December 2023. Risk factors included low albumin, high lactate dehydrogenase, and an elevated neutrophil-lymphocyte ratio. Patients were stratified into low (patients with no risk factors) and high (patients with at least one risk factor) mGRIm-s groups based on these factors.

RESULTS

Survival outcomes post-immunotherapy favored the low mGRIm-s group, with significantly improved progression-free survival (PFS) and overall survival (OS) (8.50 months vs. 3.70 months and 21.60 months vs. 8.00 months). COX regression confirmed an elevated risk in the high mGRIm-s group. Subgroup analysis highlighted a notable survival advantage for low mGRIm-s patients receiving first-line immunotherapy.

CONCLUSIONS

This study underscores mGRIm-s's potential in predicting immunotherapy response in BTC, paving the way for more targeted approaches.