The significant prognostic value of the hemoglobin, albumin, lymphocyte, and platelet (HALP) score in digestive system cancers: a systematic review and meta-analysis.

BACKGROUND: Digestive system cancers are a major global health burden, necessitating reliable and cost-effective prognostic biomarkers for clinical decision-making. The hemoglobin, albumin, lymphocyte, and platelet (HALP) score, an integrated immune-nutrition marker, has emerged as a potential prognostic tool in various malignancies. This meta-analysis evaluated the prognostic value of the HALP score in patients with digestive system cancers. METHODS: A systematic search was performed in PubMed, PMC, and Web of Science database for studies assessing HALP scores calculated from pre-treatment blood tests and reporting survival outcomes in patients with digestive system cancers. Hazard ratios (HRs) with 95% confidence intervals (CIs) were pooled to evaluate the prognostic significance of the HALP score. RESULTS: A total of 30 articles comprising 34 studies and 9,389 patients were included. High HALP scores were significantly associated with improved survival outcomes. The pooled HR for overall survival (OS) was 1.762 (95% CI: 1.570-1.977, P < 0.001), and similar results were found for disease-free survival (DFS) (HR = 1.841, 95% CI: 1.311-2.585, P < 0.001), recurrence-free survival (RFS) (HR = 1.583, 95% CI: 1.374-1.824, P < 0.001), cancer-specific survival (CSS) (HR = 1.930, 95% CI: 1.590-2.341, P < 0.001), and progression-free survival (PFS) (HR = 1.444, 95% CI: 1.068-1.954, P = 0.017). Subgroup analyses confirmed the robustness of these findings across different treatment strategies and cancer types. Sensitivity and bias analyses (P = 0.103) supported the reliability of these results. CONCLUSION: The HALP score is a promising prognostic biomarker for digestive system cancers, offering potential for clinical application in personalizing treatment strategies. Future studies should aim to standardize methodologies and validate HALP in prospective multicenter trials.