Retrospective Cohort Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 21, 2022; 28(27): 3476-3487
Published online Jul 21, 2022. doi: 10.3748/wjg.v28.i27.3476
Prognostic significance of hemoglobin, albumin, lymphocyte, platelet in gastrointestinal stromal tumors: A propensity matched retrospective cohort study
Zhou Zhao, Xiao-Nan Yin, Jian Wang, Xin Chen, Zhao-Lun Cai, Bo Zhang
Zhou Zhao, Xiao-Nan Yin, Jian Wang, Xin Chen, Zhao-Lun Cai, Bo Zhang, Department of Gastrointestinal Surgery, Sichuan University West China Hospital, Chengdu 610041, Sichuan Province, China
Author contributions: All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; and all authors took part in drafting, revising or critically reviewing the article, gave final approval of the version to be published, agreed on the journal to which the article has been submitted and agreed to be accountable for all aspects of the work.
Supported by National Natural Science Foundation of China, No. 81572931; and The 1.3.5 Project for Disciplines of Excellence, West China Hospital, Sichuan University, No. ZYJC18034.
Institutional review board statement: The Institutional Review Board of the West China Hospital of Sichuan University provided approval for this study, No. 1135(2019).
Informed consent statement: This study examined only patients' electronic health records. Each patient had been asked to sign an informed consent form authorizing the use of their electronic health record for scientific research. If the patient had not consented, we were unable to access his/her information in the hospital's information system.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The data that supporting the findings of this study are available from the corresponding author (e-mail: hxwcwk@126.com) upon reasonable request.
STROBE statement: The authors have read the STROBE Statement – checklist of items, and the manuscript was prepared and revised according to the STROBE Statement – checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Bo Zhang, MD, PhD, Professor, Department of Gastrointestinal Surgery, Sichuan University West China Hospital, No. 37 Guoxue Alley, Wuhou District, Chengdu 610041, Sichuan Province, China. hxwcwk@126.com
Received: February 11, 2022
Peer-review started: February 11, 2022
First decision: April 10, 2022
Revised: April 19, 2022
Accepted: June 19, 2022
Article in press: June 19, 2022
Published online: July 21, 2022
Abstract
BACKGROUND

The combined index of hemoglobin, albumin, lymphocyte, and platelet (HALP) can reflect systemic inflammation and nutritional status simultaneously, with some evidence revealing its prognostic value for some tumors. However, the effect of HALP on recurrence-free survival (RFS) in patients with gastrointestinal stromal tumors (GISTs) has not been reported.

AIM

To investigate the prognostic value of HALP in GIST patients.

METHODS

Data from 591 untreated patients who underwent R0 resection for primary and localized GISTs at West China Hospital between December 2008 and December 2016 were included. Clinicopathological data, preoperative albumin, blood routine information, postoperative treatment, and recurrence status were recorded. To eliminate baseline inequivalence, the propensity scores matching (PSM) method was introduced. Ultimately, the relationship between RFS and preoperative HALP was investigated.

RESULTS

The optimal cutoff value for HALP was determined to be 31.5 by X-tile analysis. HALP was significantly associated with tumor site, tumor size, mitosis, Ki67, National Institutes of Health (NIH) risk category, and adjuvant therapy (all P < 0.001). Before PSM, GIST patients with an increased HALP had a significantly poor RFS (P < 0.001), and low HALP was an independent risk factor for poor RFS [hazard ratio (HR): 0.506, 95% confidence interval (95%CI): 0.291-0.879, P = 0.016]. In NIH high-risk GIST patients, GIST patients with low HALP had a worse RFS than patients with high HALP (P < 0.05). After PSM, 458 GIST patients were identified; those with an increased HALP still had significantly poor RFS after PSM (P < 0.001) and low HALP was still an independent risk factor for poor RFS (HR: 0.558, 95%CI: 0.319-0.976, P = 0.041).

CONCLUSION

HALP was significantly correlated with postoperative pathology and postoperative treatment. Furthermore, HALP showed a strong ability to predict RFS in GIST patients who underwent radical resection.

Keywords: Gastrointestinal stromal tumors, Nutrition assessment, Immuno-inflammatory-based prognostic scores, Prognosis, Propensity score

Core Tip: The combined index of hemoglobin, albumin, lymphocyte, and platelet (HALP) can reflect systemic inflammation and nutritional status simultaneously. We demonstrated that HALP has a statistically significant correlation with postoperative pathology and postoperative treatment in patients with gastrointestinal stromal tumors (GISTs). Furthermore, we revealed that a low level of HALP was an independent risk factor for poor recurrence-free survival in GIST patients following radical resection before and after propensity scores matching.