HALP–GRIms Synergy Offers Superior Prognostic and Predictive Precision in Advanced Pancreatic Ductal Adenocarcinoma

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Abstract
Background: In the challenging landscape of metastatic pancreatic ductal adenocarcinoma (mPDAC), clinicians urgently need accessible and reliable tools to predict outcomes and guide treatment. Immunonutritional indices like the Gustave Roussy Immune Score (GRIms) and the hemoglobin, albumin, lymphocyte, and platelet (HALP) index offer promise, but their full prognostic/predictive potential remained unclear. Methods: We retrospectively analysed 201 patients with mPDAC who received first-line chemotherapy between 2020 and 2024. GRIms and HALP scores were calculated at baseline and at interval using routine blood tests. We assessed their relationship with overall survival (OS) and progression-free survival (PFS) through univariate and multivariate Cox regression models. Results: Patients with high GRIms or low HALP at baseline had significantly shorter OS and PFS (all p < 0.05), with GRIms emerging as a stronger independent predictor (HR for OS: 2.3, p < 0.001). When combined, these two scores offered even greater prognostic precision, clearly identifying the highest-risk patient for mOS (HR: 2.5, p < 0.001). Dynamic changes also mattered; patients whose GRIms increased or HALP declined over time had notably worse survival (mOS: 7 vs 12 months; HR: 3.9, p < 0.001) with combined use suggest stronger prediction (HR: 5.9, p<0.001). A high combined score was also associated with early chemotherapy resistance and poor radiologic response. Conclusion: GRIms and HALP are inexpensive, non-invasive, and readily available markers that offer stronger prognosis in mPDAC. Their combined and longitudinal use may improve clinical decision-making, help flag patients at high risk, and ultimately support more personalized and proactive treatment approaches.

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