Preoperative PIV and HALP: Correlation with Breast Cancer Pathology and Predictive Value for Microsatellite Status
Abstract
Breast cancer is a leading malignancy in women. Understanding its clinicopathological traits and microsatellite status is vital for prognosis and treatment planning. This study explored the links between preoperative pan-immune-inflammation value (PIV) and hemoglobin, albumin, lymphocyte, and platelet (HALP) score with breast cancer’s pathological features and microsatellite status and assessed their predictive power for the latter.
This retrospective study analyzed data from 260 breast cancer patients who had surgery between 2022 and 2025. Researchers not involved in the patients’ treatment collected and analyzed the data. HALP and PIV were calculated from preoperative blood tests. Patients were grouped based on the median values of these scores. Associations between the scores and clinicopathological characteristics were examined. Patients were also divided into microsatellite stable (MSS) and microsatellite instability-high (MSI-H) groups, and differences in HALP and PIV between these groups were compared. Receiver operating characteristic curves were used to evaluate the predictive accuracy of HALP and PIV for microsatellite status.
High PIV was linked to younger age and lower ER positivity. High HALP correlated with older age, a higher proportion of clinical stage I patients, and lower HER2 positivity. MSS patients had lower PIV and higher HALP than MSI-H patients. PIV and HALP showed significant correlations with microsatellite status. Both indicators had high AUC values (PIV: 0.867; HALP: 0.879), with 100% sensitivity, indicating strong predictive capabilities.
Preoperative PIV and HALP are closely tied to breast cancer’s pathological features and microsatellite status. They offer high predictive value for microsatellite status, aiding in breast cancer diagnosis and treatment decisions.
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2. Kim J, Harper A, McCormack V, Sung H, Houssami N, Morgan E, et al. Global patterns and trends in breast cancer incidence and mortality across 185 countries. Nat Med. 2025;31(4):1154-62.
3. Benitez Fuentes JD, Morgan E, de Luna Aguilar A, Mafra A, Shah R, Giusti F, et al. Global stage distribution of breast cancer at diagnosis: A systematic review and meta-analysis. JAMA Oncol. 2024;10(1):71-8.
4. Katsura C, Ogunmwonyi I, Kankam HK, Saha S. Breast cancer: presentation, investigation and management. Br J Hosp Med (Lond). 2022;83(2):1-7.
5. Roy M, Fowler AM, Ulaner GA, Mahajan A. Molecular classification of breast cancer. PET Clin. 2023;18(4):441-58.
6. Xiong X, Zheng LW, Ding Y, Chen YF, Cai YW, Wang LP, et al. Breast cancer: pathogenesis and treatments. Signal Transduct Target Ther. 2025;10(1):49.
7. Dvir K, Giordano S, Leone JP. Immunotherapy in breast cancer. Int J Mol Sci. 2024;25(14):7517.
8. Guven DC, Sahin TK, Erul E, Kilickap S, Gambichler T, Aksoy S. The association between the pan-immune-inflammation value and cancer prognosis: A systematic review and meta-analysis. Cancers (Basel). 2022;14(11):2675.
9. Qi X, Qiao B, Song T, Huang D, Zhang H, Liu Y, et al. Clinical utility of the pan-immune-inflammation value in breast cancer patients. Front Oncol. 2023;13:1223786.
10. Lin F, Zhang LP, Xie SY, Huang HY, Chen XY, Jiang TC, et al. Pan-immune-inflammation value: A new prognostic index in operative breast cancer. Front Oncol. 2022;12:830138.
11. Farag CM, Antar R, Akosman S, Ng M, Whalen MJ. What is hemoglobin, albumin, lymphocyte, platelet (HALP) score? A comprehensive literature review of HALP’s prognostic ability in different cancer types. Oncotarget. 2023;14:153-72.
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13. Xu H, Zheng X, Ai J, Yang L. Hemoglobin, albumin, lymphocyte, and platelet (HALP) score and cancer prognosis: A systematic review and meta-analysis of 13,110 patients. Int Immunopharmacol. 2023;114:109496.
14. Abdallah A, Hamdy O, Zuhdy M, Elbalka SS, Abdelkhalek M, Zaid AM, et al. The epidemiological and clinicopathological characteristics of multifocal/multicentric breast cancer in the Egyptian Delta and its impact on management strategies. Breast Dis. 2023;42(1):101-14.
15. Mouabbi JA, Hassan A, Lim B, Hortobagyi GN, Tripathy D, Layman RM. Invasive lobular carcinoma: An understudied emergent subtype of breast cancer. Breast Cancer Res Treat. 2022;193(2):253-64.
16. Nelson DR, Brown J, Morikawa A, Method M. Breast cancer-specific mortality in early breast cancer as defined by high-risk clinical and pathologic characteristics. PLoS One. 2022;17(2):e0264637.
17. Yamamoto H, Watanabe Y, Arai H, Umemoto K, Tateishi K, Sunakawa Y. Microsatellite instability: A 2024 update. Cancer Sci. 2024;115(6):1738-48.
18. Palmeri M, Mehnert J, Silk AW, Jabbour SK, Ganesan S, Popli P, et al. Real-world application of tumor mutational burden-high and microsatellite instability confirms their utility as immunotherapy biomarkers. ESMO Open. 2022;7(1):100336.
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20. Vidula N, Lipman A, Kato S, Weipert C, Hesler K, Azzi G, et al. Detection of microsatellite instability-high status by targeted plasma-based genotyping in metastatic breast cancer. NPJ Breast Cancer. 2022;8(1):117.
21. Vuković Đerfi K, Salar A, Cacev T, Kapitanović S. EMAST type of microsatellite instability: A distinct entity or blurred overlap between stable and MSI tumors. Genes (Basel). 2023;14(7):1474.
22. Kim N, Fischer AH, Dyring-Andersen B, Rosner B, Okoye GA. Research techniques made simple: Choosing appropriate statistical methods for clinical research. J Invest Dermatol. 2017;137(10):e173-8.
23. Okyar Baş A, Güner M, Ceylan S, Hafızoğlu M, Şahiner Z, Doğu BB, et al. Pan-immune inflammation value: A novel biomarker reflecting inflammation associated with frailty. Aging Clin Exp Res. 2023;35(8):1641-9.
24. Zhang C, Peng W, Ning M, Liang W, Su B, Guo T, et al. Correlation between hemoglobin, albumin, lymphocyte, and platelet score and short-term mortality in critically ill patients. J Health Popul Nutr. 2025;44(1):36.
25. Rodin D, Glicksman RM, Hepel JT, Huber K, Kirova Y, Loap P, et al. Early-stage breast cancer: A critical review of current and emerging practice. Int J Radiat Oncol Biol Phys. 2024;120(5):1260-72.
26. Montazeri Aliabadi H. Molecular targets for breast cancer therapy. Biomolecules. 2024;14(10):1219.
27. Klouch KZ, Stern MH, Trabelsi-Grati O, Kiavue N, Cabel L, Silveira AB, et al. Microsatellite instability detection in breast cancer using drop-off droplet digital PCR. Oncogene. 2022;41(49):5289-97.
28. Pannu MK, Constantinou C. Inflammation, nutrition, and clinical outcomes in breast cancer survivors: A narrative review. Curr Nutr Rep. 2023;12(4):643-61.
29. Chen W, Xin S, Xu B. Value research of NLR, PLR, and RDW in prognostic assessment of patients with colorectal cancer. J Healthc Eng. 2022;2022:7971415.
30. Muangto T, Maireang K, Poomtavorn Y, Thaweekul Y, Punyashthira A, Chantawong N, et al. Preoperative neutrophil/lymphocyte and platelet/lymphocyte ratios as predictive factors in endometrial cancer. Asian Pac J Cancer Prev. 2022;23(10):3317-22.
31. Fang T, Wang Y, Yin X, Zhai Z, Zhang Y, Yang Y, et al. Diagnostic sensitivity of NLR and PLR in early diagnosis of gastric cancer. Immunol Res. 2020;2020:9146042.
32. Ren J. Advances in combination therapy for gastric cancer: Integrating targeted agents and immunotherapy. Adv Clin Pharmacol Ther. 2024;1(1):1-15.
33. Fucà G, Guarini V, Antoniotti C, Morano F, Moretto R, Corallo S, et al. The pan-immune-inflammation value is a new prognostic biomarker in metastatic colorectal cancer. Br J Cancer. 2020;123(3):403-9.
34. Palomino-Secca I, Peña-Tuya M, Quintana-García LA, Guevara Pinares MA, Quiñones-Laveriano DM, Malpartida Palomino R, et al. Pan-immune-inflammation value and survival in patients with breast cancer from a Peruvian reference hospital. Sci Rep. 2024;14(1):17132.
35. Demir H, Demirci A, Eren SK, Beypinar I, Davarcı SE, Baykara M. A new prognostic index in young breast cancer patients. J Coll Physicians Surg Pak. 2022;32(1):86-91.
36. Espinosa-Carrasco G, Chiu E, Scrivo A, Zumbo P, Dave A, Betel D, et al. Intratumoral immune triads are required for immunotherapy-mediated elimination of solid tumors. Cancer Cell. 2024;42(7):1202-16.e8.
37. Roerden M, Spranger S. Cancer immune evasion, immunoediting and intratumour heterogeneity. Nat Rev Immunol. 2025;25(5):353-69.
38. Provenzano L, Lobefaro R, Ligorio F, Zattarin E, Zambelli L, Sposetti C, et al. Pan-immune-inflammation value and outcomes in advanced TNBC treated with platinum chemotherapy. Ther Adv Med Oncol. 2023;15:17588359231165978.
39. Şahin AB, Cubukcu E, Ocak B, Deligonul A, Oyucu Orhan S, Tolunay S, et al. Low pan-immune-inflammation value predicts better chemotherapy response and survival in breast cancer patients. Sci Rep. 2021;11(1):14662.
40. Tong L, Wang S, Zhang R, Wu Y, Xu D, Chen L. High levels of SII and PIV are risk factors for axillary lymph node metastases in breast cancer. Int J Gen Med. 2023;16:2211-8.
41. Chen XL, Xue L, Wang W, Chen HN, Zhang WH, Liu K, et al. Prognostic significance of the combination of hemoglobin, albumin, lymphocyte and platelet in gastric carcinoma. Oncotarget. 2015;6(38):41370-82.
42. François C, Mailliez A, Chretien S, Leguillette C, Oudoux A, Ceugnart L, et al. Therapeutic impact of 18F-FDG PET/CT for initial staging in early breast cancer. Breast Cancer Res Treat. 2024;207(3):551-9.
43. Pan L, Li J, Xu Q, Gao Z, Yang M, Wu X, et al. HER2/PI3K/AKT pathway in HER2-positive breast cancer. Medicine (Baltimore). 2024;103(24):e38508.
44. Jiang T, Sun H, Xue S, Xu T, Xia W, Wang Y, et al. Prognostic significance of HALP score in breast cancer: A propensity score-matching study. Cancer Cell Int. 2024;24(1):230.
45. Zhao Z, Xu L. Prognostic significance of HALP score in early breast cancer. Front Oncol. 2023;13:1253895.
46. Renault V, Tubacher E, How-Kit A. Assessment of microsatellite instability from next-generation sequencing data. Adv Exp Med Biol. 2022;1361:75-100.
47. Bacher JW, Udho EB, Strauss EE, Vyazunova I, Gallinger S, Buchanan DD, et al. A highly sensitive pan-cancer test for microsatellite instability. J Mol Diagn. 2023;25(11):806-26.
2. Kim J, Harper A, McCormack V, Sung H, Houssami N, Morgan E, et al. Global patterns and trends in breast cancer incidence and mortality across 185 countries. Nat Med. 2025;31(4):1154-62.
3. Benitez Fuentes JD, Morgan E, de Luna Aguilar A, Mafra A, Shah R, Giusti F, et al. Global stage distribution of breast cancer at diagnosis: A systematic review and meta-analysis. JAMA Oncol. 2024;10(1):71-8.
4. Katsura C, Ogunmwonyi I, Kankam HK, Saha S. Breast cancer: presentation, investigation and management. Br J Hosp Med (Lond). 2022;83(2):1-7.
5. Roy M, Fowler AM, Ulaner GA, Mahajan A. Molecular classification of breast cancer. PET Clin. 2023;18(4):441-58.
6. Xiong X, Zheng LW, Ding Y, Chen YF, Cai YW, Wang LP, et al. Breast cancer: pathogenesis and treatments. Signal Transduct Target Ther. 2025;10(1):49.
7. Dvir K, Giordano S, Leone JP. Immunotherapy in breast cancer. Int J Mol Sci. 2024;25(14):7517.
8. Guven DC, Sahin TK, Erul E, Kilickap S, Gambichler T, Aksoy S. The association between the pan-immune-inflammation value and cancer prognosis: A systematic review and meta-analysis. Cancers (Basel). 2022;14(11):2675.
9. Qi X, Qiao B, Song T, Huang D, Zhang H, Liu Y, et al. Clinical utility of the pan-immune-inflammation value in breast cancer patients. Front Oncol. 2023;13:1223786.
10. Lin F, Zhang LP, Xie SY, Huang HY, Chen XY, Jiang TC, et al. Pan-immune-inflammation value: A new prognostic index in operative breast cancer. Front Oncol. 2022;12:830138.
11. Farag CM, Antar R, Akosman S, Ng M, Whalen MJ. What is hemoglobin, albumin, lymphocyte, platelet (HALP) score? A comprehensive literature review of HALP’s prognostic ability in different cancer types. Oncotarget. 2023;14:153-72.
12. Antar R, Farag C, Xu V, Drouaud A, Gordon O, Whalen MJ. Evaluating the baseline hemoglobin, albumin, lymphocyte, and platelet (HALP) score in the United States adult population and comorbidities: An analysis of NHANES. Front Nutr. 2023;10:1206958.
13. Xu H, Zheng X, Ai J, Yang L. Hemoglobin, albumin, lymphocyte, and platelet (HALP) score and cancer prognosis: A systematic review and meta-analysis of 13,110 patients. Int Immunopharmacol. 2023;114:109496.
14. Abdallah A, Hamdy O, Zuhdy M, Elbalka SS, Abdelkhalek M, Zaid AM, et al. The epidemiological and clinicopathological characteristics of multifocal/multicentric breast cancer in the Egyptian Delta and its impact on management strategies. Breast Dis. 2023;42(1):101-14.
15. Mouabbi JA, Hassan A, Lim B, Hortobagyi GN, Tripathy D, Layman RM. Invasive lobular carcinoma: An understudied emergent subtype of breast cancer. Breast Cancer Res Treat. 2022;193(2):253-64.
16. Nelson DR, Brown J, Morikawa A, Method M. Breast cancer-specific mortality in early breast cancer as defined by high-risk clinical and pathologic characteristics. PLoS One. 2022;17(2):e0264637.
17. Yamamoto H, Watanabe Y, Arai H, Umemoto K, Tateishi K, Sunakawa Y. Microsatellite instability: A 2024 update. Cancer Sci. 2024;115(6):1738-48.
18. Palmeri M, Mehnert J, Silk AW, Jabbour SK, Ganesan S, Popli P, et al. Real-world application of tumor mutational burden-high and microsatellite instability confirms their utility as immunotherapy biomarkers. ESMO Open. 2022;7(1):100336.
19. Horimoto Y, Thinzar Hlaing M, Saeki H, Kitano S, Nakai K, Sasaki R, et al. Microsatellite instability and mismatch repair protein expressions in lymphocyte-predominant breast cancer. Cancer Sci. 2020;111(7):2647-54.
20. Vidula N, Lipman A, Kato S, Weipert C, Hesler K, Azzi G, et al. Detection of microsatellite instability-high status by targeted plasma-based genotyping in metastatic breast cancer. NPJ Breast Cancer. 2022;8(1):117.
21. Vuković Đerfi K, Salar A, Cacev T, Kapitanović S. EMAST type of microsatellite instability: A distinct entity or blurred overlap between stable and MSI tumors. Genes (Basel). 2023;14(7):1474.
22. Kim N, Fischer AH, Dyring-Andersen B, Rosner B, Okoye GA. Research techniques made simple: Choosing appropriate statistical methods for clinical research. J Invest Dermatol. 2017;137(10):e173-8.
23. Okyar Baş A, Güner M, Ceylan S, Hafızoğlu M, Şahiner Z, Doğu BB, et al. Pan-immune inflammation value: A novel biomarker reflecting inflammation associated with frailty. Aging Clin Exp Res. 2023;35(8):1641-9.
24. Zhang C, Peng W, Ning M, Liang W, Su B, Guo T, et al. Correlation between hemoglobin, albumin, lymphocyte, and platelet score and short-term mortality in critically ill patients. J Health Popul Nutr. 2025;44(1):36.
25. Rodin D, Glicksman RM, Hepel JT, Huber K, Kirova Y, Loap P, et al. Early-stage breast cancer: A critical review of current and emerging practice. Int J Radiat Oncol Biol Phys. 2024;120(5):1260-72.
26. Montazeri Aliabadi H. Molecular targets for breast cancer therapy. Biomolecules. 2024;14(10):1219.
27. Klouch KZ, Stern MH, Trabelsi-Grati O, Kiavue N, Cabel L, Silveira AB, et al. Microsatellite instability detection in breast cancer using drop-off droplet digital PCR. Oncogene. 2022;41(49):5289-97.
28. Pannu MK, Constantinou C. Inflammation, nutrition, and clinical outcomes in breast cancer survivors: A narrative review. Curr Nutr Rep. 2023;12(4):643-61.
29. Chen W, Xin S, Xu B. Value research of NLR, PLR, and RDW in prognostic assessment of patients with colorectal cancer. J Healthc Eng. 2022;2022:7971415.
30. Muangto T, Maireang K, Poomtavorn Y, Thaweekul Y, Punyashthira A, Chantawong N, et al. Preoperative neutrophil/lymphocyte and platelet/lymphocyte ratios as predictive factors in endometrial cancer. Asian Pac J Cancer Prev. 2022;23(10):3317-22.
31. Fang T, Wang Y, Yin X, Zhai Z, Zhang Y, Yang Y, et al. Diagnostic sensitivity of NLR and PLR in early diagnosis of gastric cancer. Immunol Res. 2020;2020:9146042.
32. Ren J. Advances in combination therapy for gastric cancer: Integrating targeted agents and immunotherapy. Adv Clin Pharmacol Ther. 2024;1(1):1-15.
33. Fucà G, Guarini V, Antoniotti C, Morano F, Moretto R, Corallo S, et al. The pan-immune-inflammation value is a new prognostic biomarker in metastatic colorectal cancer. Br J Cancer. 2020;123(3):403-9.
34. Palomino-Secca I, Peña-Tuya M, Quintana-García LA, Guevara Pinares MA, Quiñones-Laveriano DM, Malpartida Palomino R, et al. Pan-immune-inflammation value and survival in patients with breast cancer from a Peruvian reference hospital. Sci Rep. 2024;14(1):17132.
35. Demir H, Demirci A, Eren SK, Beypinar I, Davarcı SE, Baykara M. A new prognostic index in young breast cancer patients. J Coll Physicians Surg Pak. 2022;32(1):86-91.
36. Espinosa-Carrasco G, Chiu E, Scrivo A, Zumbo P, Dave A, Betel D, et al. Intratumoral immune triads are required for immunotherapy-mediated elimination of solid tumors. Cancer Cell. 2024;42(7):1202-16.e8.
37. Roerden M, Spranger S. Cancer immune evasion, immunoediting and intratumour heterogeneity. Nat Rev Immunol. 2025;25(5):353-69.
38. Provenzano L, Lobefaro R, Ligorio F, Zattarin E, Zambelli L, Sposetti C, et al. Pan-immune-inflammation value and outcomes in advanced TNBC treated with platinum chemotherapy. Ther Adv Med Oncol. 2023;15:17588359231165978.
39. Şahin AB, Cubukcu E, Ocak B, Deligonul A, Oyucu Orhan S, Tolunay S, et al. Low pan-immune-inflammation value predicts better chemotherapy response and survival in breast cancer patients. Sci Rep. 2021;11(1):14662.
40. Tong L, Wang S, Zhang R, Wu Y, Xu D, Chen L. High levels of SII and PIV are risk factors for axillary lymph node metastases in breast cancer. Int J Gen Med. 2023;16:2211-8.
41. Chen XL, Xue L, Wang W, Chen HN, Zhang WH, Liu K, et al. Prognostic significance of the combination of hemoglobin, albumin, lymphocyte and platelet in gastric carcinoma. Oncotarget. 2015;6(38):41370-82.
42. François C, Mailliez A, Chretien S, Leguillette C, Oudoux A, Ceugnart L, et al. Therapeutic impact of 18F-FDG PET/CT for initial staging in early breast cancer. Breast Cancer Res Treat. 2024;207(3):551-9.
43. Pan L, Li J, Xu Q, Gao Z, Yang M, Wu X, et al. HER2/PI3K/AKT pathway in HER2-positive breast cancer. Medicine (Baltimore). 2024;103(24):e38508.
44. Jiang T, Sun H, Xue S, Xu T, Xia W, Wang Y, et al. Prognostic significance of HALP score in breast cancer: A propensity score-matching study. Cancer Cell Int. 2024;24(1):230.
45. Zhao Z, Xu L. Prognostic significance of HALP score in early breast cancer. Front Oncol. 2023;13:1253895.
46. Renault V, Tubacher E, How-Kit A. Assessment of microsatellite instability from next-generation sequencing data. Adv Exp Med Biol. 2022;1361:75-100.
47. Bacher JW, Udho EB, Strauss EE, Vyazunova I, Gallinger S, Buchanan DD, et al. A highly sensitive pan-cancer test for microsatellite instability. J Mol Diagn. 2023;25(11):806-26.
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| Issue | Articles in Press | |
| Section | Brief Communication | |
| Keywords | ||
| Breast cancer Inflammation Microsatellite instability Nutritional status | ||
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How to Cite
1.
Dong L, Zhao Y, Sun Y, Cui F. Preoperative PIV and HALP: Correlation with Breast Cancer Pathology and Predictive Value for Microsatellite Status. Iran J Allergy Asthma Immunol. 2026;:1-14.
