Prognostic Value of Hemoglobin, Albumin, Lymphocyte, Platelet (HALP) Score in Patients with Metastatic Renal Cell Carcinoma Treated with Nivolumab.

Background: Immunotherapy based on checkpoint inhibition is widely used in the treatment of metastatic renal cell carcinoma (RCC); however, predictive and prognostic biomarkers are yet to be explored. The objective of this study was to evaluate the prognostic value of the hemoglobin, albumin, lymphocyte, platelet (HALP) score in metastatic RCC patients receiving nivolumab.

Methods: We enrolled 149 individuals (including 38 females) with a median age of 62 years, who were treated with nivolumab (at a dosage of 240 mg biweekly or 480 mg every 28 days) following progression on at least one tyrosine kinase inhibitor (TKI) between 2016 and 2024. The study population was dichotomized by the median HALP score (27.53), which was calculated as hemoglobin (g/L) × albumin (g/L) × absolute lymphocyte count/platelets (g/L) at immunotherapy initiation. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method, with differences analyzed via a log-rank test. A multivariate Cox proportional hazards model was utilized for evaluation of the prognostic value of performance status, lactate dehydrogenase (LDH) levels, and HALP score.

Results: At a median follow-up of 31.1 months, 122 patients had progressed on nivolumab and 87 had died. Poor performance status was associated with significantly worse PFS and OS (HR 0.20 and 0.14, respectively). Survival was worse in individuals with an LDH level higher than 1.5 times the normal range compared to those with lower LDH values (HR 0.45 for PFS and HR 0.41 for OS). Patients with low HALP scores had shorter PFS (HR 0.69) and OS (HR 0.58) versus patients with high HALP scores. In the multivariate analysis, the independent prognostic value of the HALP index for OS was revealed in a metastatic clear-cell RCC (ccRCC) population.

Conclusions: The HALP score determined before nivolumab initiation as the second or third line of treatment is an independent prognostic factor of OS in metastatic ccRCC patients. Prospective validation could lead to the incorporation of this index into prognostic models for patients with RCC.