Abstract
PURPOSE: The hemoglobin, albumin, lymphocyte, and platelet (HALP) score is a novel immune nutritional index associated with the prognosis of various malignancies. This study aimed to evaluate the clinical relevance of the HALP score in predicting recurrence, metastasis, and survival outcomes in patients with testicular cancer. METHODS: This retrospective study included 131 patients with histologically confirmed testicular cancer who were treated between January 2010 and December 2024. HALP scores were calculated using the baseline laboratory parameters. An optimal cutoff value of 304.56 was identified using receiver operating characteristic (ROC) curve analysis (AUC: 0.820; 95% CI 0.708-0.902; p < 0.001). Patients were stratified into high and low HALP groups based on this threshold value. Survival outcomes were evaluated using Kaplan-Meier, and Cox proportional hazards regression analyses. RESULTS: The median HALP score was 531.1 (IQR: 348.8-728.5). A low HALP score (≤ 304.56) was significantly associated with poorer 1-year overall survival (54.5% vs. 98.2%, p < 0.001) and a 15.6-fold increased risk of death (HR 15.604, 95% CI 2.718-89.645, p = 0.001) based on Cox regression analysis. In the multivariate analysis, a low HALP score (HR: 7.684, p = 0.016), the presence of comorbidity (HR 13.528, p = 0.002), and tunica albuginea invasion (HR 7.255, p = 0.030) were identified as independent predictors of recurrence or metastasis. In addition, the HALP score was significantly associated with disease stage (p < 0.001), with lower scores more commonly observed in patients with advanced-stage disease. CONCLUSIONS: The HALP score was a simple, inexpensive, and effective prognostic biomarker in testicular cancer. A score ≤ 304.56 is independently associated with a higher risk of recurrence, metastasis, and mortality. Incorporating HALP into routine assessments may improve risk stratification and clinical decision-making in this patient population.