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UPJ INSIGHT: Biomarker Surrogate for Nutritional Status to Predict Overall Survival in Patients Post–radical Cystectomy
By: Christian M. Farag, BA, George Washington University School of Medicine, Washington, District of Columbia; Sinan Akosman, BA, George Washington University School of Medicine, Washington, District of Columbia; Jennica Luu, BS, George Washington University School of Medicine, Washington, District of Columbia; Shawn Haji-Momenian, MD, George Washington University School of Medicine, Washington, District of Columbia; Michael J. Whalen, MD, George Washington University School of Medicine, Washington, District of Columbia | Posted on: 18 May 2023
Farag CM, Akosman S, Luu J, Haji-Momenian S, Whalen MJ. Hemoglobin, albumin, lymphocyte, and platelet count is a significant biomarker surrogate for nutritional status to predict overall survival in patients post–radical cystectomy. Urol Pract. 2023;10(3):261-269.
Study Need and Importance
Patients who undergo radical cystectomy (RC) are at risk for malnutrition for a variety of reasons. A prognostic marker for underlying nutritional and immune status is of much value in urologic oncology because patients can be better screened and targeted with pre-/perioperative immunonutritional therapy, with the goal being to improve post-RC outcomes. Our paper sought to validate the hemoglobin, albumin, lymphocyte, platelet score (HALP) as a surrogate for immunological and nutritional status to predict RC postoperative outcomes.
What We Found
We found that low HALP scores are a predictor for shorter overall survival (see Figure). HALP remained predictive even when adjusting for comorbidities, TNM staging, and neoadjuvant chemotherapy. We determined that an optimum HALP cutoff of 25.0 is clinically meaningful to preoperatively screen patients for nutritional deficiency. This finding is in line with a previous study which identified 22.2 as an optimum threshold in RC, which further lends credence to the utility of HALP.
Limitations
This study is limited by a small sample size (n=50) and clinical data collected from only a single institution. Furthermore, some of the patients in our sample underwent neoadjuvant chemotherapy, which has an unknown effect on the HALP score. Although our study adjusted for neoadjuvant chemotherapy, neoadjuvant chemotherapy may have nevertheless impacted HALP scores across groups.
Interpretation for Patient Care
HALP is potentially a powerful predictor of overall survival following RC. Given that HALP evaluates nutritional and immunological status, it is possible to use HALP to screen for patients who may be in need of preoperative nutritional and immune therapy. Future research should investigate if preoperative HALP score can be improved by administrating preoperative nutritional supplementation, with the goal of improving the arsenal of preoperative interventions to aid malnourished patients undergoing surgery.
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