Prognostic Value of the CALLY Index in Hypopharyngeal Cancer Treated with Definitive Chemoradiotherapy: A...

Background: The hypopharyngeal region is among the most aggressive sites of head and neck squamous cell carcinoma, often presenting at an advanced stage with poor survival outcomes. However, there are only a limited number of biomarkers available to predict the prognosis of this aggressive disease. Recent interest has focused on immunonutritional biomarkers that may improve prognostication. The C-reactive protein-albumin-lymphocyte (CALLY) index has emerged as a composite biomarker integrating systemic inflammation, nutritional status, and immune competence. However, its clinical relevance in hypopharyngeal cancer has not been established. Methods: This retrospective, single-center study included patients with histologically confirmed hypopharyngeal squamous cell carcinoma treated with definitive chemoradiotherapy between 2010 and 2024. Patients were excluded from the study if they had incomplete laboratory data, had a concomitant malignancy, were undergoing induction chemotherapy, or had diseases affecting inflammatory and immunological markers. The CALLY index was calculated using pre-treatment laboratory values. Receiver operating characteristic (ROC) analysis determined the optimal cut-off value for overall survival (OS). Kaplan-Meier survival estimates and Cox regression analyses were used to assess associations between the CALLY index and progression-free survival (PFS), local recurrence-free survival (LRFS), and OS. Results: A total of 71 patients were included. The optimal CALLY cut-off was 1.47 (AUC = 0.70, p = 0.006). Patients with a CALLY index ≥ 1.47 had significantly improved median PFS (37 vs. 9 months, p = 0.003), LRFS (39 vs. 9 months, p = 0.002), and OS (61 vs. 11 months, p = 0.002). In multivariate analysis, the CALLY index and T stage remained independent prognostic factors of all three survival outcomes. Conclusions: The pretreatment CALLY index is a practical, accessible biomarker that independently predicts survival in hypopharyngeal cancer. Its integration into clinical practice may enhance risk stratification and guide individualized management strategies.