Predictive value of the HALP score for lymph node metastasis in resectable gastric cancer

Abstract

Objective: This study aimed to evaluate the predictive value of the hemoglobin, albumin, lymphocyte, and platelet (HALP) score for lymph node metastasis (LNM) in patients with resectable gastric cancer and to investigate the relationship between hematological markers and LNM.

Materials and Methods: Patients who underwent surgery for gastric adenocarcinoma between 2020 and 2024 were retrospectively analyzed. Demographic data, comorbidities, and laboratory parameters were recorded, and the HALP score, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and platelet-to-neutrophil ratio (PNR) were calculated. Tumor stage, nodal stage, and pathological features were reviewed. The optimal HALP cutoff value was determined by receiver operating characteristic (ROC) curve analysis. Variables significant in univariate analysis were included in multivariate logistic regression to identify independent risk factors for LNM.

Results: A total of 238 patients were included, with a mean age of 65.5 ± 11.4 years; 70.2% were male. The mean number of dissected lymph nodes was 26.0 ± 10.6, and the mean number of metastatic nodes was 6.2 ± 9.0. Perineural invasion (PNI) and lymphovascular invasion (LVI) were observed in 66.8% and 71.0% of patients, respectively. LNM was present in 159 patients (66.8%). In univariate analysis, a low HALP score, advanced invasion depth, and the presence of PNI and LVI were significantly associated with LNM (p < 0.005). ROC analysis identified an optimal HALP cutoff value of 17 (AUC = 0.581, p = 0.041). In multivariate analysis, invasion depth (p = 0.001), PNI (p = 0.008), and LVI (p < 0.001) were independent predictors of LNM, whereas the HALP score was not (p = 0.221).

Conclusion: In resectable gastric cancer, a low HALP score was associated with lymph node metastasis but was not confirmed as an independent predictive factor. As a composite parameter reflecting systemic inflammation and immune–nutritional status, the HALP score may indicate tumor aggressiveness and poor prognosis. Preoperative recognition of low HALP(<17) scores may help identify patients requiring closer monitoring for LNM risk.