Abstract
OBJECTIVES: To investigate the relationship between the HALP score and recurrence in hepatocellular carcinoma (HCC) patients treated with transarterial chemoembolization (TACE) and ablation. METHODS: We collected clinical data from 728 HCC patients who underwent TACE and ablation from January 2018 to December 2023. Patients with high HALP scores (H-HALP, n=422) were stratified into a training cohort (n=296) and an internal validation cohort (n=126), while an external validation cohort (n=147) was independently enrolled. Lasso-Cox regression was employed to identify independent risk factors for recurrence-free survival (RFS), and a nomogram was constructed. The predictive accuracy of nomogram was evaluated using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA). RESULTS: Although the median RFS in the H-HALP group longer than the L-HALP group (1.84 vs. 1.60 years, P=0.024), recurrence rates remained substantial in H-HALP patients (1-/3-/5-year RFS: 70.8%/36.2%/21.5%). The nomogram, integrating cirrhosis, tumor numbers, and γ-glutamyl transpeptidase (GGT), demonstrated moderate predictive accuracy for 1-/3-/5-year RFS in the training cohort (AUC: 0.665/0.694/0.671) and internal validation cohort (AUC: 0.622/0.606/0.561). External validation yielded AUCs of 0.569 (1-year), 0.615 (3-year), and 0.662 (4-year). Calibration curves indicated strong agreement between predicted and observed outcomes, while DCA confirmed clinical utility. Risk stratification based on nomogram scores revealed significantly prolonged RFS in low-risk versus high-risk groups across all cohorts. CONCLUSION: The HALP score alone showed limited prognostic value in this cohort; however, the Lasso-Cox regression-based nomogram effectively stratified recurrence risk in H-HALP patients treated with TACE and ablation.