Abstract
Background: Lung cancer remains the leading cause of global cancer mortality. The HALP (hemoglobin, albumin, lymphocyte, platelet) score integrates nutritional, immune, and inflammatory status and may offer prognostic value. This meta-analysis evaluates the association between the HALP score and survival outcomes in lung cancer patients. Methods: Following PRISMA guidelines, PubMed, Embase, Web of Science, CNKI, Wanfang, and Google Scholar were searched. Inclusion criteria covered observational studies in lung cancer reporting hazard ratios (HRs) for overall survival (OS), progression-free survival (PFS), or disease-free survival (DFS). Study quality was assessed via the Newcastle-Ottawa Scale (NOS). Random-effects models were used to pool HRs (95% confidence intervals [CIs]), with subgroup and sensitivity analyses used to address heterogeneity. Results: Fourteen studies (N = 10,182 patients) were included. A high HALP score predicted significantly improved OS in multivariate analysis (HR = 0.56, 95% CI: 0.46-0.69, p < 0.001), representing a 44% mortality risk reduction. The results were consistent for surgical (HR = 0.60, CI: 0.43-0.84), advanced (HR = 0.47, CI: 0.32-0.69), and all-stage subgroups. High HALP also correlated with superior PFS (multivariate HR = 0.56, CI: 0.39-0.78, p = 0.001) but not DFS (HR = 0.50, CI: 0.22-1.16, p = 0.107). Significant heterogeneity persisted (I(2) > 75% for OS), likely due to stage variability and non-standard HALP cutoffs. Publication bias was detected for OS studies (Egger's p = 0.003). Conclusions: The HALP score is a low-cost, accessible prognostic biomarker for lung cancer. A high HALP score independently predicts better OS and PFS but not DFS, suggesting utility for long-term risk stratification. Standardized HALP thresholds and validation in diverse populations are needed for clinical implementation.