The C-reactive Protein-Albumin-Lymphocyte Index Predicts Survival Outcomes in Esophageal Cancer: A Meta-Analysis

The C-reactive protein-albumin-lymphocyte (CALLY) index represents a novel composite biomarker integrating systemic inflammation, nutritional status, and immune function. This systematic review and meta-analysis aimed to evaluate the prognostic significance of the CALLY index in esophageal cancer patients. A comprehensive literature search was conducted across multiple databases from inception to August 2025, identifying studies that investigated the association between the CALLY index and survival outcomes in histologically confirmed esophageal cancer patients. The majority of studies employed retrospective cohort designs, with three being single-center studies and two utilizing multi-center approaches. The studies were conducted between 2024 and 2025, with four originating from Asian populations and one from a Western population. Meta-analysis revealed that patients with higher CALLY index values experienced significantly better overall survival compared to those with lower values (risk ratio (RR): 2.24, 95% CI: 1.71-2.94, p<0.001), despite moderate heterogeneity (I²=62%). Similarly, a higher CALLY index was associated with improved disease-free survival (RR: 1.99, 95% CI: 1.65-2.40, p<0.001) with no heterogeneity observed (I²=0%). Sensitivity analyses confirmed the robustness of these findings. The CALLY index demonstrates significant prognostic value in esophageal cancer, with lower values indicating worse outcomes. This composite biomarker may serve as a valuable tool for risk stratification and treatment planning, potentially guiding personalized therapeutic approaches. However, standardization of cut-off values and validation through prospective studies are needed to establish its clinical utility.