Efficacy of the HALP Score in Predicting Progression in Patients Undergoing Radical Cystectomy for Muscle Invasive Bladder Cancer

Objective: This study investigated the prognostic value of the HALP score, comprising haemoglobin, albumin, lymphocyte, and platelet parameters, on progression and progression-free survival (PFS) in patients undergoing radical cystectomy (RC) for non-metastatic muscle-invasive bladder cancer (MIBC). Material and Methods: A retrospective analysis was conducted on 134 MIBC patients who underwent RC between February 2014 and January 2024. The HALP score was calculated using the formula: HALP = (haemoglobin × albumin × lymphocytes) / platelets. Associations between HALP score, clinicopathological parameters, progression, and PFS were assessed via Kaplan-Meier survival analysis, ROC curve analysis, and multivariate logistic regression. Results: The median HALP score was significantly lower in patients with disease progression (29.19 [IQR: 19.17–41.81]) compared to those without progression (37.55 [IQR: 29.61–52.25]; p = 0.021). Patients with a HALP score <36.38 had a mean PFS of 68.8 months (95% CI: 52.6–85.1), compared to 82.4 months (95% CI: 66.5–98.2) in patients with a HALP score ≥36.38 (p=0.021). ROC analysis yielded an AUC of 0.619 (95% CI: 0.518–0.721) for predicting progression, with sensitivity and specificity of 54.9% and 55.4%, respectively. Perineural invasion (PNI) emerged as an independent prognostic factor for progression (OR=2.56, 95% CI: 1.011–6.482, p=0.047), and low preoperative albumin levels significantly increased progression risk (p=0.032). Conclusions: Although the HALP score is a statistically significant prognostic marker for predicting progression in patients with MIBC, it has limited predictive power. Our results demonstrate the potential of the HALP score as a helpful tool in individualised treatment approaches. However, the prognostic value of the HALP score needs to be confirmed in prospective and multicentre studies in larger patient populations.