Prognostic Significance of Hemoglobin, Albumin, Lymphocyte and Platelet (HALP) Score in Hepatocellular Carcinoma

Figures & data

Table 1 Clinical Features of All Patients

Features	N=273	Features	N=273
Gender (male/female)	238 (87.2%)/35 (12.8%)	Monocyte (*10^9/L)	0.46 (0.35–0.60)
Age	53.99 ± 10.74	Hemoglobin (g/L)	140.00 (127.50–151.50)
HBsAg^a (+/-)	214 (78.4%)/59 (21.6%)	Platelet (*10^9/L)	164.00 (119.50–222.00)
Liver cirrhosis (yes/no)	139 (50.9%)/134 (49.1%)	ALT^e (U/L)	25.00 (20.00–37.00)
Tumor number (1/≥2)	241 (88.3%)/32 (11.7%)	AST^f (U/L)	27.00 (22.00–38.00)
Tumor diameter	4.70 (3.00–7.00)	Albumin (g/L)	41.251 ± 4.354
TNM^b stage (I–II/III–IV)	212 (77.7%)/61 (22.3%)	TBil^g (μmol/L)	13.00 (9.80–16.25)
Cell differentiation (poor/moderate/well)	122 (44.7%)/134 (49.1%)/17 (6.2%)	ALP^h (U/L)	77.00 (60.50–101.00)
MVI^c status (+/-)	71 (26.0%)/202 (74.0%)	γ-GT^i (U/L)	49.00 (30.00–101.00)
WBC^d (*10^9/L)	5.27 (4.31–6.77)	PT^j (S)	13.80 (13.30–14.40)
Neutrophil (*10^9/L)	3.10 (2.39–4.14)	AFP^k (ng/mL)	85.12 (5.50–1446.00)
Lymphocyte (*10^9/L)	1.48 (1.14–1.87)

Notes: ^aHepatitis B surface antigen; ^bTumor node metastasis; ^cMicrovascular invasion; ^dWhite blood cell; ^eAlanine aminotransferase; ^fAspartate aminotransferase; ^gTotal bilirubin; ^hAlkaline phosphatase; ⁱγ-glutamyl transpeptidase; ^jProthrombin time; ^kAlpha-fetoprotein.

Figure 1 Overall survival curves of all patients after surgical resection.

Figure 2 The ROC curves of PT, GPR, Fib-4, ALT/AST and HALP score.

Table 2 Relationship Between HALP Score and Clinical Features in Patients

Features	HALP^e
	High (n=134)	Low (n=139)	P value
Gender			P=0.250
Male	120 (89.6%)	118 (84.9%)
Female	14 (10.4%)	21 (15.1%)
Age (years)			P=0.130
<60	87 (64.9%)	102 (73.4%)
≥60	47 (35.1%)	37 (26.6%)
HBsAg^a			P=0.548
Positive	103 (76.9%)	111 (79.9%)
Negative	31 (23.1%)	28 (20.1%)
Liver cirrhosis			P=0.101
Yes	75 (56.0%)	64 (46.0%)
No	59 (44.0%)	75 (54.0%)
Cell differentiation			P=0.770
Poor	57 (42.5%)	65 (46.8%)
Moderate	68 (50.7%)	66 (47.5%)
Well	9 (6.7%)	8 (5.8%)
Microvascular invasive			P=0.583
Positive	37 (27.6%)	34 (24.5%)
Negative	97 (72.4%)	105 (75.5%)
Tumor number			P=0.076
=1	123 (91.8%)	118 (84.9%)
≥2	11 (8.2%)	21 (15.1%)
TNM^b stage			P=0.001
I–II	115 (85.8%)	97 (69.8%)
III–IV	19 (14.2%)	42 (30.2%)
AFP^c			P=0. 092
>7.00 ng/mL	92 (68.7%)	108 (77. 7%)
≤7.00 ng/mL	42 (31.3%)	31 (22. 3%)
PT^d			P=0.789
≥14.35s	37 (27.6%)	41 (29.5%)
<14.35s	97 (72.4%)	98 (70.5%)
Treatment protocol			P=0.727
Surgery only	78 (58.2%)	78 (56.1%)
Combined treatment	56 (41.8%)	61 (43.9%)

Notes: ^aHepatitis B surface antigen; ^bTumor node metastasis; ^cAlpha-fetoprotein; ^dProthrombin time; ^eHemoglobin, albumin, lymphocyte, and platelet.

Table 3 Univariate and Multivariate Analysis of Factors for OS

Variable	Univariate Analysis		Multivariate Analysis
	Hazard Ratio (95% CI)	P	Hazard Ratio (95% CI)	P
Gender (male/female)	0.505 (0.265–0.964)	0.038	0.426 (0.217–0.833)	0.013
Age (<60 years/≥60 years)	0.871 (0.601–1.261)	0.464
Liver cirrhosis (yes/no)	0.971 (0.684–1.377)	0.868
TNM^a stage (I–II/III–IV)	1.383 (0.929–2.057)	0.110
Cell differentiation (poor/moderate-well)	1.136 (0.798–1.618)	0.480
Microvascular invasion (positive/negative)	1.530 (1.054–2.222)	0.025	0.652 (0.447–0.950)	0.026
Tumor number (=1/≥2)	1.113 (0.659–1.881)	0.688
HBsAg^b (positive/negative)	0.956 (0.625–1.464)	0.837
AFP^c (≤7.00 ng/mL/>7.00 ng/mL)	0.953 (0.669–1.358)	0.791
PT^d (<14.35s/≥14.35s)	1.324 (0.914–1.918)	0.138
ALT/AST^e (<0.568/≥0.568)	1.673 (1.037–2.700)	0.035	1.845 (1.093–3.114)	0.022
Fib-4^f (<2.824/≥2.824)	0.635 (0.440–0.916)	0.015	0.737 (0.488–1.112)	0.146
GPR^g (<0.205/≥0.205)	0.584 (0.394–0.866)	0.007	0.673 (0.443–1.021)	0.063
HALP score^h (<54.132/≥54.132)	1.527 (1.072–2.176)	0.019	1.708 (1.192–2.448)	0.004
Treatment protocol (surgery only/combined treatment)	1.913 (1.348–2.716)	<0.001	1.882 (1.321–2.681)	<0.001

Notes: ^aTumor node metastasis; ^bHepatitis B surface antigen; ^cAlpha-fetoprotein; ^dProthrombin time; ^eAlanine aminotransferase/aspartate aminotransferase; ^fFibrosis-4 score; ^gγ-glutamyl transpeptidase to platelet ratio; ^hHemoglobin, albumin, lymphocyte, and platelet.

Figure 3 Overall survival curves of HCC patients after surgical resection based on gender (a), microvascular invasion (b), ALT/AST (c), HALP score (d) and treatment protocol (e).

Figure 4 Kaplan–Meier curves of OS according to different HALP scores in patients with TNM I–II stage (a), TNM III–IV stage (b), AFP positive (c), and AFP negative (d).