Preoperative halp score in gastric cancer patients undergoing upfront gastrectomy: Clinicopathological associations and survival outcomes

Abstract

Aim: This study aimed to evaluate the association of the preoperative hemoglobin–albumin–lymphocyte–platelet (HALP) score with clinicopathological characteristics and overall survival in gastric cancer patients undergoing primary curative-intent gastrectomy.Materials and Methods: This retrospective single-center study included patients who underwent gastrectomy for histologically confirmed gastric adenocarcinoma between January 2010 and December 2025. Of 149 initially evaluated patients, 12 who received neoadjuvant treatment were excluded, and 137 patients were analyzed. The HALP score was evaluated as a continuous variable and was also categorized into low and high HALP groups according to the cohort median value of 34.97. Overall survival was assessed using the Kaplan–Meier method. Factors associated with survival were examined using univariable and multivariable Cox regression analyses.Results: Sixty-seven patients were classified into the low HALP group and seventy patients into the high HALP group. Low HALP was associated with larger tumor diameter and a higher frequency of perioperative transfusion. Five-year overall survival was numerically lower in the low HALP group; however, the difference was not statistically significant (49.2% vs. 60.5%; p=0.552). In univariable analysis, HALP was not associated with overall survival as either a continuous or categorical variable. In the multivariable model, nodal stage and perioperative transfusion were independently associated with overall survival, whereas median-based low HALP was not an independent prognostic factor.Conclusions: The preoperative HALP score may reflect baseline immunonutritional status in gastric cancer patients undergoing primary gastrectomy. However, median-based low HALP was not independently associated with overall survival after adjustment. Therefore, HALP should be interpreted cautiously as a standalone prognostic marker.