| Sumario: | Simple Summary: Prognostic assessment in metastatic renal cell carcinoma may be improved by incorporating simple markers that reflect both tumor-related systemic inflammation and the general condition of the patient. The hemoglobin, albumin, lymphocyte, and platelet (HALP) score combines routinely measured parameters related to anemia, nutritional status, immune response, and inflammation. In this large, multicenter, real-world study, we evaluated the prognostic value of pretreatment HALP in patients with metastatic renal cell carcinoma receiving first-line tyrosine kinase inhibitor (TKI) therapy. The HALP-low group had a significantly shorter time to treatment failure and overall survival than the HALP-high group. These findings suggest that HALP may be a useful prognostic marker in patients receiving first-line TKI therapy and support its further evaluation in future studies. Background/Objectives: The hemoglobin, albumin, lymphocyte, and platelet (HALP) score has been investigated as an immunonutritional biomarker in several solid tumors; however, data in metastatic renal cell carcinoma (mRCC) remain limited. This study aimed to evaluate the prognostic significance of the pretreatment HALP score in patients with mRCC receiving first-line tyrosine kinase inhibitor (TKI) therapy. Methods: A multicenter retrospective cohort study was conducted using data from the Turkish Oncology Group Kidney Cancer Consortium (TKCC) Database. HALP was calculated as hemoglobin (g/dL) × albumin (g/dL) × lymphocyte count (×109/L)/platelet count (×109/L). Patients were categorized into HALP-low and HALP-high groups according to the cohort median HALP value. Results: A total of 1001 patients were enrolled. The median time to treatment failure (TTF) was significantly shorter in the HALP-low group than in the HALP-high group (7.43 months [95% CI 6.4–8.5] vs. 14.26 months [95% CI 12.1–16.4], p < 0.001). The median overall survival (OS) was also significantly shorter in the HALP-low group (30.19 months [95% CI 25.2–35.1] vs. 46.06 months [95% CI 38.2–53.9], p < 0.001). In multivariable analysis, a high HALP score remained independently associated with longer TTF (HR 0.73, 95% CI 0.62–0.86; p < 0.001) and OS (HR 0.69, 95% CI 0.57–0.85; p < 0.001). Conclusions: The pretreatment HALP score was independently associated with TTF and OS in patients with mRCC treated with first-line TKI therapy. These findings support the prognostic relevance of HALP in this treatment setting and warrant further evaluation of its potential role alongside established clinical risk models.
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