Haemoglobin, albumin, lymphocyte and platelet predicts postoperative survival in pancreatic cancer

Table 1 Clinicopathological features of patients with resected pancreatic cancer, n (%)

Features	n = 582
Age [yr, median (range)]	61 (29-82)
Gender (male/female)	319(54.8)/263(45.2)
Tumour location (head/body, tail)	243(41.8)/339 (58.2)
Preoperative CA19-9 (> 37 U/mL/≤ 37 U/mL)	440 (75.6)/142 (24.4)
HALP (> 44.56/≤ 44.56)	351 (60.3)/231 (39.7)
NLR (> 2.20/≤ 2.20)	287 (49.3)/295 (50.7)
PLR (> 112.94/≤ 112.94)	331 (56.9)/251 (43.1)
PNI (> 53.10/≤ 53.10)	249 (42.8)/333 (57.2)
Tumour size (cm, median (range))	4.0 (0.3-11.5)
Lymph node metastasis (more than 3/1-3/0 positive lymph nodes)	75 (12.9)/210 (36.1)/297 (51.0)
Total lymph nodes resected [median (range)]	12 (1-69)
TNM stage (IA/IB/IIA/IIB/III)	39 (6.7)/164 (28.2)/94 (16.2)/210 (36.0)/75 (12.9)
Differentiation (well, moderate/poor)	361 (62.0)/221 (38.0)
Neural invasion (yes/no)	476 (81.8)/106 (18.2)
Microvascular invasion (yes/no)	126 (21.6)/456 (78.4)

HALP: Hemoglobin, albumin, lymphocyte, and platelet; NLR: Neutrophil-to-lymphocyte ratio; PLR: Platelet-to-lymphocyte ratio; PNI: Prognostic nutritional index.

Table 2 Relationship between hemoglobin, albumin, lymphocyte, and platelet and clinical features in patients with resected pancreatic cancer

Features	HALP
	Low (≤ 44.56, n = 231)	High (> 44.56, n = 351)	P value
Age (yr)			0.161
≤ 62	112	191
> 62	119	160
Gender			0.005
Female	121	142
Male	110	209
Preoperative CA19-9			0.473
≤ 37 U/mL	60	82
> 37 U/mL	171	269
NLR			< 0.001
≤ 2.20	77	218
> 2.20	154	133
PLR			< 0.001
≤ 112.94	17	234
> 112.94	214	117
PNI			< 0.001
≤ 53.10	187	146
> 53.10	44	205
Tumor location			< 0.001
Head	122	121
Body/Tail	109	230
TNM stage			0.008
IA	13	26
IB	59	105
IIA	30	64
IIB	86	124
III	43	32
Tumor size			0.718
≤ 4.0 cm	146	227
> 4.0 cm	85	124
Lymph node metastasis			0.002
0	102	195
1-3	86	124
> 3	43	32
Tumor differentiation			0.032
Well/Moderate	131	230
Poor	100	121
Neural invasion			0.672
No	44	62
Yes	187	289
Microvascular invasion			1.000
No	173	283
Yes	58	68

HALP: Hemoglobin, albumin, lymphocyte, and platelet; NLR: Neutrophil-to-lymphocyte ratio; PLR: Platelet-to-lymphocyte ratio; PNI: Prognostic nutritional index.

Table 3 Univariate and multivariate analysis for overall survival in subgroups of patients with resected pancreatic cancer

Features	OS						RFS
	Univariate analysis			Multivariate analysis			Univariate analysis			Multivariate analysis
	HR	95%CI	P value	HR	95%CI	P value	HR	95%CI	P value	HR	95%CI	P value
Age	0.874	0.683-1.119	0.286			NS	0.896	0.737-1.090	0.273			NS
Gender (male versus female)	1.312	1.021-1.686	0.034			NS	1.196	0.982-1.456	0.075			NS
Tumor location (body/tail versus head)	0.925	0.722-1.185	0.538			NS	0.976	0.806-1.188	0.805			NS
Preoperative CA19-9 (> 37 U/mL/≤ 37 U/mL)	1.871	1.355-2.585	< 0.001	1.629	1.176-2.258	0.003	1.543	1.218-1.955	< 0.001	1.45	1.143-1.839	0.002
HALP (> 44.56/≤ 44.56)	0.605	0.472-0.774	< 0.001	0.601	0.433-0.835	< 0.001	0.633	0.520-0.772	< 0.001	0.678	0.556-0.828	< 0.001
NLR (> 2.20/≤ 2.20)	1.654	1.289-2.122	< 0.001	1.394	1.062-1.831	0.017	1.442	1.185-1.754	< 0.001			NS
PLR (> 112.94/≤ 112.94)	1.272	0.990-1.634	0.06			NS	1.277	1.047-1.557	0.016			NS
PNI (> 53.10/≤ 53.10)	0.663	0.511-0.860	0.002			NS	0.764	1.650-1.970	0.024			NS
TNM stage (III/IIB/IIA/IB/IA)	1.39	1.240-1.558	< 0.001	1.302	1.161-1.461	< 0.001	1.294	1.184-1.413	< 0.001	1.236	1.132-1.350	< 0.001
Tumor size (> 4.0/≤ 4.0 cm)	1.586	1.237-2.034	< 0.001			NA	1.334	1.092-1.630	0.005			NA
Lymph node metastasis (more than 3/1-3/0 nodes)	1.658	1.395-1.970	< 0.001			NA	1.533	1.334-1.761	< 0.001			NA
Total lymph nodes resected	0.992	0.979-1.006	0.246			NS	1.001	0.991-1.011	0.868			NS
Differentiation (well, moderate versus poor)	2.192	1.711-2.808	< 0.001	1.988	1.547-2.555	< 0.001	1.791	1.467-2.187	< 0.001	1.672	1.367-2.043	< 0.001
Neural invasion (yes versus no)	1.533	1.078-2.182	0.018			NS	1.358	1.041-1.772	0.024			NS
Microvascular invasion (yes versus no)	1.424	1.070-1.894	0.015			NS	1.306	1.037-1.646	0.024			NS

HALP: Hemoglobin, albumin, lymphocyte, and platelet; NLR: Neutrophil-to-lymphocyte ratio; PLR: Platelet-to-lymphocyte ratio; PNI: Prognostic nutritional index; OS: Overall survival; RFS: Recurrence-free survival; HR: Hazard ratio; CI: Confidence interval; NA: Not adopted; NS: Not significant.