The predictive value of Hemoglobin–Albumin–Lymphocyte–Platelet score for maximal cytoreduction surgery in advanced-stage epithelial ovarian cancer

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OBJECTIVE: The Hemoglobin-Albumin-Lymphocyte-Platelet score has shown prognostic value across various cancers; however, its utility in predicting cytoreductive outcomes in advanced epithelial ovarian cancer remains unclear. The aim of this study was to determine whether the preoperative Hemoglobin-Albumin-Lymphocyte-Platelet score predicts maximal cytoreduction at primary cytoreductive surgery. METHODS: In this single-center study, we analyzed data from 140 patients with epithelial ovarian cancer who underwent primary cytoreductive surgery at our clinic. Patients were categorized by residual disease: maximal cytoreduction (no macroscopic residual disease, n=104), optimal cytoreduction (n=19), and suboptimal cytoreduction (n=17). Preoperative Hemoglobin-Albumin-Lymphocyte-Platelet, CA-125, and clinical variables were compared across groups. Discrimination for maximal cytoreduction was assessed using receiver operating characteristic analysis. RESULTS: The maximal cytoreduction group had higher preoperative hemoglobin and lymphocyte counts, lower platelet counts, and lower CA-125 levels (p<0.005). Median Hemoglobin-Albumin-Lymphocyte-Platelet was significantly higher in maximal cytoreduction vs. optimal cytoreduction vs. suboptimal cytoreduction (35.37 vs. 21.10 vs. 20.19; all p<0.001). For predicting maximal cytoreduction, the Hemoglobin-Albumin-Lymphocyte-Platelet cutoff of 24.96 yielded a sensitivity of 71.4% and a specificity of 71.4% (area under the curve: 0.792; p<0.001). A CA-125 cutoff of 260.50 IU/mL provided a sensitivity of 71.4% and a specificity of 65.7% (area under the curve: 0.758; p<0.001). CONCLUSION: The preoperative Hemoglobin-Albumin-Lymphocyte-Platelet score demonstrates good discrimination for predicting maximal cytoreduction in advanced epithelial ovarian cancer and appears to perform at least comparably to CA-125. Given that patients selected for neoadjuvant chemotherapy were excluded, these performance estimates apply to a surgically selected population. Given its low cost and universal availability, Hemoglobin-Albumin-Lymphocyte-Platelet may support preoperative selection and counseling before cytoreductive surgery.

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