Integrative prognostic value of the CALLY index in cancer patients undergoing surgical resection

The C-reactive protein-albumin-lymphocyte (CALLY) index has recently gained attention as an inflammation- and nutrition-based biomarker with promising prognostic implications in oncology. However, its predictive accuracy across diverse malignancies in patients undergoing curative-intent surgery has not yet been systematically validated.

A systematic review and meta-analysis were performed by searching PubMed, EMBASE, and the Cochrane Library up to July 2025. Eligible studies included cancer patients undergoing curative-intent surgery and reporting outcomes stratified by preoperative CALLY index. Hazard ratios (HRs) and odds ratios (ORs) were pooled using fixed- or random-effects models, depending on interstudy heterogeneity. Internal validation was conducted using a retrospective hepatocellular carcinoma (HCC) cohort from our institution ( n = 234).

Thirty-eight studies encompassing 12 591 patients were included. Lower preoperative CALLY index was significantly associated with worse overall survival (HR: 1.91, P < 0.001), recurrence-free survival (HR: 1.88, P < 0.001), cancer-specific survival (HR: 2.51, P < 0.001), and a higher risk of major postoperative complications (OR: 2.07, P = 0.005). Subgroup analyses confirmed consistent associations across cancer type, geographic origin of the cohort, the Cox regression model applied, or the threshold used to dichotomize CALLY levels. The prognostic relevance of CALLY was further validated in our HCC cohort, where elevated CALLY index correlated with improved survival outcomes.

The CALLY index is a promising and readily measurable prognostic biomarker for surgically treated cancer patients. Its integration into routine preoperative assessment may enhance individualized risk stratification and perioperative decision-making.