Combined halp and GRIm scores for risk stratification in metastatic pancreatic ductal adenocarcinoma.

AIMS: Simple and accessible biomarkers are needed to improve prognostic assessment in metastatic pancreatic ductal adenocarcinoma (mPDAC). Immunonutritional indices derived from routine blood tests, such as the hemoglobin-albumin-lymphocyte-platelet (HALP) score and the Gustave Roussy Immune Score (GRIms), have shown prognostic relevance, but their combined and dynamic value remains unrevealed. METHODS: We retrospectively evaluated 201 patients with mPDAC who received first-line chemotherapy between 2020 and 2024. Baseline and interval HALP and GRIms values were calculated using routine laboratory parameters. Associations with overall survival (OS) and progression-free survival (PFS) were assessed using Cox proportional hazards models. RESULTS: Higher GRIms and lower HALP were associated with shorter OS and PFS (all p < 0.05). GRIms remained an independent prognostic factor in multivariable analyses. A combined HALP-GRIms score provided improved risk stratification and identified a subgroup with markedly reduced survival. Moreover, unfavorable changes in these scores during treatment were associated with poorer clinical outcomes. CONCLUSIONS: HALP and GRIms, particularly when evaluated in combination and over time, offer practical prognostic information in mPDAC. These findings support their role in baseline risk stratification and warrant further prospective validation.