Predictive value of HALP and GNRI scores in the prognosis of first-line immunotherapy combined with chemotherapy for advanced/recurrent gastric cancer
MA Shanyi
LI Chunyan
CHENG Zhiyuan
WU Fangfang
WU Xiaodong
DONG Jun
WANG Ping
Abstract：Objective To investigate the prognostic value of the hemoglobin,albumin,lymphocyte,and platelet(HALP)score and the geriatric nutritional risk index(GNRI)in advanced/recurrent gastric cancer patients receiving immunotherapy combined with chemotherapy.Methods A total of 102 patients with advanced/recurrent gastric cancer who received first-line treatment(sintilimab or tislelizumab combined with XELOX or FOLFOX regimen)between July 2021 and June 2024 at Xuancheng Central Hospital were enrolled.Clinicopathological data were collected,and HALP and GNRI scores before treatment were calculated.Cox proportional hazards regression model was employed to analyze prognostic factors.Kaplan-Meier survival analysis was utilized to assess the association between HALP/GNRI scores and progression-free survival(PFS).Receiver operating characteristic curve analysis was conducted to evaluate the prognostic value of combining HALP,GNRI,and carbohydrate antigen 724(CA724).Results The prognosis-favorable group(n=49)demonstrated significantly higher HALP(91.63±70.57)and GNRI(174.96±128.44)scores compared to the prognosis-unfavorable group(n=53)(HALP:47.62±56.62;GNRI:78.34±83.66;P<0.001).Combination of HALP,GNRI,and CA724 improved the area under the curve for predicting prognosis to 0.890(95%CI:0.812-0.943),with superior sensitivity and specificity over any single indicator.High HALP and GNRI scores were significantly associated with multiple favorable clinicopathological features,including a higher proportion of stage Ⅲ disease(high HALP:25.5%vs.low:9.8%;high GNRI:26.1%vs.low:10.7%),better tumor differentiation(high HALP:82.4%vs.low:49.0%),lower T4 invasion rate(high HALP:19.6%vs.low:49.0%;high GNRI:19.6%vs.low:46.4%),reduced lymph node metastasis(high HALP:64.7%vs.low:86.3%;high GNRI:67.4%vs.low:82.1%),and higher programmed death-ligand 1(PD-L1)positivity(high HALP:76.5%vs.low:45.1%).Survival analysis revealed that the high HALP group had a significantly longer median progression-free survival(PFS)than the low score group(14.5 vs.9.2 months,P=0.002),and the high GNRI group also showed superior PFS compared to the low score group(15.2 vs.8.8 months,P<0.001).The composite high HALP/high GNRI group achieved the best prognosis with a median PFS of 16.8 months.Multivariate analysis identified Lauren classification,TNM stage,PD-L1 combined positive score<5,elevated CA724,low HALP,and low GNRI scores as independent prognostic factors.Conclusion High HALP and GNRI scores are associated with favorable prognosis and advantageous clinicopathological features in advanced/recurrent gastric cancer,whereas low HALP and low GNRI serve as independent risk factors.The combination of HALP,GNRI,and CA724 significantly enhances prognostic predictive efficacy,suggesting its potential value as a biomarker for risk stratification and treatment decision-making.
Keywords：Gastric cancerHemoglobinalbuminlymphocyte and platelet count(HALP)scoresGeriatric nutritional risk index(GNRI)PrognosisDiagnosis
Publication Date：2025-07-28
Online Publishing Date：2025-10-17(First online date of this platform, not the publication date of the document)
Pages：7( 673-679 )