The role of the preoperative HALP score in predicting pathological T and N categories in colon cancer: a single-center retrospective study
TL;DR
The findings suggest that the HALP score may serve as an adjunctive biomarker that could contribute to preoperative risk assessment in patients with colon cancer.
Abstract
Objective The HALP score is an easily accessible immunonutritional biomarker that may reflect systemic inflammation and nutritional status. This study aimed to evaluate the association of the preoperative HALP score with pathological T (pT) and N (pN) categories in patients with colon cancer. In addition, the performance of the HALP score in distinguishing between early (pT1–2) and advanced (pT3–4) T categories was investigated. Methods This single-center retrospective study included 100 patients who underwent elective surgery for nonmetastatic colon cancer between December 2020 and December 2025. Patients who received neoadjuvant treatment, had M1 disease, or underwent emergency surgery because of bleeding or obstruction were excluded. The HALP score was calculated using hemoglobin, albumin, lymphocyte, and platelet values obtained from peripheral venous blood within one week before surgery. Discriminative performance was evaluated using ROC analysis, and cut-off values were determined using the Youden index. Results The patients were evaluated in three comparison groups: in Group 1, patients with pN0 disease were compared with those with pN+ disease; in Group 2, patients with pT1–2/pN0 disease were compared with all other patients; and in Group 3, patients with pT1–2 disease were compared with those with pT3–4 disease, irrespective of pN status. The discriminative performance of the HALP score was not significant in Group 1 (AUC = 0.53; 95% CI: 0.42–0.65; p = 0.568), whereas the AUC was 0.77 in Group 2 (95% CI: 0.64–0.89; p < 0.001) and 0.81 in Group 3 (95% CI: 0.71–0.92; p < 0.001). At the cut-off value of 55.37 determined for Groups 2 and 3, sensitivity was 55.0% and 60.0%, respectively, while specificity was 91.2% and 96.0%, respectively. These results demonstrated that Group 3 had statistically better diagnostic performance than Group 2. Conclusion In colon cancer, the HALP score was able to distinguish between early (pT1–2) and advanced (pT3–4) T categories, irrespective of pN status. Our findings suggest that the HALP score may serve as an adjunctive biomarker that could contribute to preoperative risk assessment in patients with colon cancer. The study findings should be validated in larger, prospective, multicenter cohorts.