HALP score outperforms systemic inflammatory biomarkers for prognosis in locally advanced rectal cancer

Peipei Shen; Tiantian Yang; Yawen Cong; Bin Zhang; Yu Xu; Benjie Xu; Shengjun Ji; Yutian Zhao; Yong Mao

doi:10.17305/bb.2026.13845

Authors

Peipei Shen Department of Radiotherapy and Oncology, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China https://orcid.org/0009-0007-2982-6737
Tiantian Yang Wuxi Medical College, Jiangnan University, Wuxi, Jiangsu, China https://orcid.org/0009-0006-6250-5663
Yawen Cong Wuxi Medical College, Jiangnan University, Wuxi, Jiangsu, China https://orcid.org/0009-0002-7393-4894
Bin Zhang Department of Anesthesiology, The Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China https://orcid.org/0009-0006-8685-6791
Yu Xu Department of Radiotherapy and Oncology, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China
Benjie Xu Department of Outpatient Chemotherapy, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang, China
Shengjun Ji Department of Radiotherapy and Oncology, Suzhou Municipal Hospital, The affiliated Suzhou Hospital of Nanjing Medical University, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, China https://orcid.org/0000-0002-8862-6256
Yutian Zhao Department of Radiotherapy and Oncology, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China https://orcid.org/0000-0001-8003-593X
Yong Mao Department of Oncology, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China

DOI:

https://doi.org/10.17305/bb.2026.13845

Keywords:

Locally advanced rectal cancer, inflammation, biomarker, prognosis

Abstract

The prognostic value of systemic inflammatory and nutritional biomarkers in patients with locally advanced rectal cancer (LARC) remains inadequately defined. This multicenter retrospective study comprehensively assessed the prognostic performance of twelve inflammation-based indices, aiming to identify the most informative biomarker for patients undergoing neoadjuvant chemoradiotherapy followed by surgery. We analyzed data from 427 patients with stage II–III LARC treated at three medical centers between 2010 and 2021. Twelve biomarkers, derived from routine pretreatment blood parameters—including hemoglobin, albumin, neutrophils, lymphocytes, monocytes, and platelets—were evaluated for their association with overall survival (OS) and disease-free survival (DFS). The prognostic performance was measured using the concordance index (C-index), time-dependent area under the receiver operating characteristic curve (time-AUC), and Brier score. Among the evaluated biomarkers, the hemoglobin–albumin–lymphocyte–platelet (HALP) score exhibited robust and consistent prognostic performance. For OS, HALP achieved a C-index of 0.687 and a time-AUC of 0.668, along with the lowest Brier score (0.134); similar results were observed for DFS (C-index 0.675, time-AUC 0.665). Patients with low HALP scores had significantly worse OS and DFS compared to those with high HALP scores. Multivariate Cox regression analysis confirmed low HALP as an independent risk factor for OS (HR = 3.937, 95% CI: 2.445-6.329; p < 0.001) and DFS (HR = 2.212, 95% CI: 1.577-3.096; p < 0.001). Nomograms integrating HALP with key clinicopathological variables provided incremental prognostic value, demonstrating good discrimination and calibration at 12, 36, and 60 months. These findings indicate that HALP is a simple and cost-effective biomarker for prognostic stratification in LARC.

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