Core Tip: The combined index of hemoglobin, albumin, lymphocyte, and platelet (HALP) can reflect systemic inflammation and nutritional status simultaneously. We demonstrated that HALP also has a statistically significant correlation with postoperative pathology and postoperative treatment in patients with gastrointestinal stromal tumors (GISTs). Furthermore, we revealed that a low level of HALP was an independent risk factor for poor recurrence-free survival in GIST patients following radical resection before and after propensity scores matching.

INTRODUCTION

Gastrointestinal stromal tumors (GISTs), a rare type of tumor, are the most frequent mesenchymal tumors arising from the gastrointestinal tract[1]. GISTs may occur anywhere in the digestive tract and even occasionally outside the gastrointestinal tract, with the stomach accounting for 60% and the small intestine 30% of all GISTs[2]. The morphology, immunohistochemistry, and molecular markers are helpful to the diagnosis of GISTs. Surgical resection is the standard treatment for resectable GISTs[3]. Nowadays, novel small molecular tyrosine kinase inhibitors, such as imatinib and sunitinib, have revolutionized the integrated treatment of GISTs and greatly improved the long-term prognosis of patients[4].
Some GIST-specific parameters based on postoperative pathologies, such as tumor size, primary tumor location, mitotic index, and tumor rupture, have been used to stratify the risk of recurrence for GISTs[2, 5-7]. Meanwhile, a recent effort has shed light on the role of preoperative cancer-related inflammation and nutrition status in progression of various cancers, such as those of gastric[8], colorectal[9], non-small lung[10], and GIST[11-15][微软用户1] [z2] . Several preoperative immuno-inflammatory-based prognostic scores, such as the preoperative neutrophil-to-lymphocyte ratio (NLR), the lymphocyte-to-monocyte ratio (LMR), and the platelet-to-lymphocyte ratio (PLR), reflect the systematic inflammatory response, with some evidence supporting their prognostic ability for GISTs[13-17]. Furthermore, nutritional status, such as measured by the prognostic nutritional index (PNI), has also been shown to play an important role in GIST progression[10, 11].
Recent studies have proposed a new combined index of hemoglobin, albumin, lymphocyte, and platelet (HALP) which can reflect systemic inflammation and nutritional status simultaneously[18]. It has already been reported as related to the prognosis of patients with pancreatic cancer[19], renal cancer[20], gastric cancer[18], prostate cancer[21], bladder cancer[22], esophageal cancer[23], and small cell lung cancer[24]. However, there are no studies on the relationship between HALP and recurrence in GIST patients who undergo radical resection. Therefore, this study aimed to investigate the prognostic value of preoperative HALP in resected GIST patients.
 [微软用户1]It is our policy to cite no more than 5 references in a row in the same citation box, e.g. [1-6], [1-19].
 [z2]We have removed citation 16 from the citation box, but not from the References Section; this will not affect the reference numbering and reading flow.