Prognostic Significance and Clinical Robustness of the HALP Score in Super‐Elderly Patients Undergoing Curative Gastrectomy for Gastric Cancer: A Multicenter Retrospective Cohort Study

Background Management of super‐elderly patients (aged ≥ 80 years) with gastric cancer (GC) has become an increasingly important clinical issue. We aimed to evaluate the prognostic significance of preoperative “hemoglobin, albumin, lymphocyte, and platelet” (HALP) scores, which may reflect both tumor‐ and host‐related conditions, in super‐elderly patients with GC. Methods This study included 507 super‐elderly patients who underwent curative gastrectomy for GC at 10 hospitals. HALP scores were calculated as follows: hemoglobin × albumin × lymphocytes/platelets. We evaluated the prognostic significance and clinical robustness of the HALP score. Results Preoperative HALP scores ranged from 1.628 to 289.201 (median, 50.795), and the optimal cutoff value for predicting overall survival (OS) was 42.382, based on receiver operating characteristic curve analysis. Multivariate analysis identified that male sex, high preoperative carcinoembryonic antigen levels, poor performance status, pT3/4, pN(+), and low HALP scores (hazard ratio [HR], 2.23; 95% confidence interval, 1.63–3.04; p < 0.001) were independent risk factors for poor OS. We demonstrated the robustness of the prognostic significance of the HALP score using quartile, continuous variable, leave‐one‐center‐out, and subgroup analyses. In addition, a low HALP score was independently associated with worse cancer‐specific survival (HR, 2.08) and other‐cause mortality (HR, 2.39), suggesting that the HALP score may reflect both tumor‐ and host‐related conditions in super‐elderly patients with GC. Conclusion The HALP score appears to be a clinically useful and robust prognostic biomarker that may contribute to prognostic stratification and clinical decision‐making in super‐elderly patients with GC undergoing curative gastrectomy.