To determine the utility of hemoglobin, albumin, lymphocyte, platelet (HALP) score in stratifying muscle-invasive bladder cancer (MIBC) patients according to their response to neoadjuvant chemotherapy (NAC) prior to radical cystectomy (RC).
Using an IRB-approved database, patients with MIBC who received NAC were retrospectively evaluated between February 2018 and November 2023. X-tile was used to generate a HALP cutoff score based on overall survival, and NAC response was compared between the prechemotherapy clinical stage and the pathological stage at RC. Logistic regressions were performed to identify demographic or clinical factors associated with NAC response.
We stratified 70 MIBC patients using a pre-NAC HALP score of 25.0 into Low HALP (N = 18) and High HALP (N = 52) groups. There was a positive association between high pre-NAC HALP score and complete response to NAC vs. no response (OR = 3.14, P = 0.113, 95% CI: 0.76-12.91). Patients from the Low HALP group had a higher rate of no response to NAC at 66.7% vs. 44.2%, and patients from the High HALP group had a higher rate of complete response to NAC at 34.6% vs. 16.7%.
Patients in the Low HALP group had a very high rate of nonresponse while patients in the High HALP group had a 2.1 times greater likelihood of having a complete response to NAC compared to those in the Low HALP group. This work is hypothesis-generating suggesting that pre-treatment HALP has the potential to help identify patients who may not benefit from NAC.
Urologic oncology. 2026 Feb 20 [Epub ahead of print]
Max H Stempel, John P Quezada, Brie Belz, Fionna Sun, Jennifer M Lobo, Nassib Heidar, Tracey L Krupski
University of Virginia School of Medicine, Charlottesville, VA., Department of Urology, University of Virginia Health System, Charlottesville, VA., Department of Urology, University of Virginia Health System, Charlottesville, VA; Department of Public Health Sciences, University of Virginia, Charlottesville, VA., Department of Urology, University of Virginia Health System, Charlottesville, VA. Electronic address: .
PubMed http://www.ncbi.nlm.nih.gov/pubmed/41723077