HALP Score Acts as Prognostic Biomarker for Survival Outcomes in NSCLC

Survival in individuals living with non–small cell lung cancer (NSCLC) could be predicted through the use of the hemoglobin, albumin, lymphocyte, and platelet (HALP) score, according to a new meta-analysis published in Frontiers in Immunology,¹ as it integrates aspects of systemic inflammation and nutritional status to work as a prognostic tool.

HALP scores can act as a prognostic biomarker for survival in patients with NSCLC | Image credit: appledesign - stock.adobe.com

NSCLC is the most common type of lung cancer, and the most common type of cancer worldwide, with 80% to 85% of lung cancer diagnoses being NSCLC diagnoses.² The prognosis for NSCLC remains low and is influenced by tumor stage, grade, and treatment strategy among other factors. The HALP score has been used as a prognostic tool for other types of cancer and is gaining interest in the NSCLC space. This meta-analysis aimed to assess the prognostic role of the HALP score using data from previous studies.

The researchers used PubMed, Embase, Web of Science, Cochrane Library, and ClinicalTrials.gov to find studies on the prognostic value of HALP. All studies through December 2024 were eligible for inclusion. Studies included in the meta-analysis were prospective or retrospective cohort studies, included patients diagnosed with NSCLC, included HALP scores of the patients, and had outcome measures that included progression-free survival (PFS) and overall survival. Reviews, conference abstracts, commentary articles, and case reports were not included. All data were extracted to include patient characteristics, survival outcomes, and intervention measures.

There were 10 articles that included 7024 patients that were included in the final meta-analysis. Therapeutic resection was included in 5 of the studies, adjuvant chemotherapy was included in 4, and immunotherapy was included in 1. All studies were published between 2021 and 2024 and were conducted in China, Turkey, Italy, and the United Kingdom. The follow-up period varied between 25.3 and 64 months and the HALP cut-off values ranged between 24.3 and 48.2.

HALP scores were significantly associated with age (older vs younger: OR, 1.43; 95% CI, 1.15-1.78) and tumor size (large vs small: OR, 0.54; 95% CI, 0.38-0.76). Gender, smoking history, overall stage, and lymph node metastasis had no significant association with HALP scores.

Poorer OS was significantly associated with a lower pretreatment HALP score (HR, 1.73; 95% CI, 1.27-2.34). Only studies using receiver operating characteristic thresholds showed this association between lower HALP score and poor OS. Worse PFS was also found in patients who had a decreased HALP score (HR, 1.86; 95% CI, 1.30-2.64). A sensitivity analysis found that both of these results did not significantly change.

There were some limitations to this meta-analysis. The studies had significant heterogeneity, which could undermine the generalizability. The studies did not all included detailed data on treatment protocols. Infection, steroid therapy, and other medications could affect inflammatory biomarkers. Differences in calculating HALP could prevent accurate comparability. The included studies also did not consistently report any management of anemia. Follow-up durations were short in some of the studies.

The researchers concluded that HALP scores were associated with worse survival outcomes in patients with NSCLC. Future studies, they said, should focus on validating these results with more diverse populations.

“These findings highlight the potential of the HALP score as an effective prognostic biomarker, providing crucial prognostic information for NSCLC patients,” the authors concluded.

References

1. Li Q, Chen M, Zhao H, Zeng J. The prognostic and clinicopathological value of HALP score in non-small cell lung cancer. Front Immunol. Published online June 26, 2025. doi:10.3389/fimmu.2025.1576326

2. Non-small cell lung cancer. Cleveland Clinic. Updated January 16, 2025. Accessed July 11, 2025. https://my.clevelandclinic.org/health/diseases/6203-non-small-cell-lung-cancer