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Background <p>Reliable preoperative prognostic tools that comprehensively reflect host-related factors remain limited for gastric cancer (GC). The C-reactive protein–albumin–lymphocyte (CALLY) index integrates systemic inflammation, nutritional status, and immune competence. We evaluated its prognostic performance compared with commonly used inflammation–nutrition indices.</p> Methods <p>We conducted a single-center retrospective cohort study of consecutive patients undergoing curative gastrectomy for gastric adenocarcinoma, with temporal validation. Preoperative laboratory parameters obtained within 1&#xa0;week before surgery were used to calculate the CALLY index. Outcomes included overall survival (OS), disease-free survival (DFS), and 30&#xa0;day postoperative morbidity. Discrimination was assessed using receiver operating characteristic (ROC) analysis; survival outcomes were analyzed using Kaplan–Meier methods and multivariable Cox regression; postoperative morbidity was evaluated using multivariable logistic regression.</p> Results <p>The development cohort included 992 patients, and the temporal validation cohort included 302 patients. In the development cohort, the optimal CALLY cutoff was 2.61. For 5&#xa0;year OS, the CALLY index showed the highest discriminative ability (AUC = 0.708), comparable to mGPS (AUC = 0.705) and superior to other indices (AUC ≤ 0.675). A low CALLY index was significantly associated with poorer OS and DFS (both <i>p</i> &lt; 0.001) and remained independently prognostic after multivariable adjustment (OS HR 1.56, 95% CI 1.20–2.03; DFS HR 1.48, 95% CI 1.16–1.90). Low CALLY was also independently associated with increased risks of overall and severe postoperative complications, with consistent directions observed in the validation cohort.</p> Conclusions <p>The preoperative CALLY index independently predicts long-term survival and short-term postoperative morbidity in patients with GC undergoing curative gastrectomy. Compared with conventional inflammation–nutrition scores, CALLY shows comparable-to-slightly better and more consistent prognostic performance across endpoints, although absolute gains in discrimination are modest. Prospective multicenter validation with standardized assays, prespecified analyses, and recalibration is warranted.</p> Graphical abstract <p></p>

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The CALLY index as a comprehensive inflammation–nutrition–immunity marker for prognosis in gastric cancer surgery

  • 期刊论文

  • 发表日期：

    2026年2月23日

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  • Guanghao Liu,
  • Shuai Zhao,
  • Mingyu Xia,
  • Kai Zheng,
  • Dailong Lu,
  • Houchen Zhu,
  • Daorong Wang

摘要

Background

Reliable preoperative prognostic tools that comprehensively reflect host-related factors remain limited for gastric cancer (GC). The C-reactive protein–albumin–lymphocyte (CALLY) index integrates systemic inflammation, nutritional status, and immune competence. We evaluated its prognostic performance compared with commonly used inflammation–nutrition indices.

Methods

We conducted a single-center retrospective cohort study of consecutive patients undergoing curative gastrectomy for gastric adenocarcinoma, with temporal validation. Preoperative laboratory parameters obtained within 1 week before surgery were used to calculate the CALLY index. Outcomes included overall survival (OS), disease-free survival (DFS), and 30 day postoperative morbidity. Discrimination was assessed using receiver operating characteristic (ROC) analysis; survival outcomes were analyzed using Kaplan–Meier methods and multivariable Cox regression; postoperative morbidity was evaluated using multivariable logistic regression.

Results

The development cohort included 992 patients, and the temporal validation cohort included 302 patients. In the development cohort, the optimal CALLY cutoff was 2.61. For 5 year OS, the CALLY index showed the highest discriminative ability (AUC = 0.708), comparable to mGPS (AUC = 0.705) and superior to other indices (AUC ≤ 0.675). A low CALLY index was significantly associated with poorer OS and DFS (both p < 0.001) and remained independently prognostic after multivariable adjustment (OS HR 1.56, 95% CI 1.20–2.03; DFS HR 1.48, 95% CI 1.16–1.90). Low CALLY was also independently associated with increased risks of overall and severe postoperative complications, with consistent directions observed in the validation cohort.

Conclusions

The preoperative CALLY index independently predicts long-term survival and short-term postoperative morbidity in patients with GC undergoing curative gastrectomy. Compared with conventional inflammation–nutrition scores, CALLY shows comparable-to-slightly better and more consistent prognostic performance across endpoints, although absolute gains in discrimination are modest. Prospective multicenter validation with standardized assays, prespecified analyses, and recalibration is warranted.

Graphical abstract