Prognostic Significance of the CALM Index in Surgically Resected Non-Small Cell Lung Cancer

Area of Science:

• Oncology
• Biomarker Research
• Clinical Prognostics

Background:

• Anatomical staging alone is inadequate for predicting outcomes in early-stage non-small cell lung cancer (NSCLC) after curative resection.
• Prognostic variability in stage I-IIIA NSCLC necessitates novel biomarkers for improved patient stratification.

Purpose of the Study:

• To evaluate the prognostic value of the C-reactive protein-albumin-lymphocyte-monocyte (CALM) index for overall survival (OS) in resected stage I-IIIA NSCLC patients.
• To assess the CALM index's ability to provide incremental prognostic information beyond established clinical factors.

Main Methods:

• Retrospective analysis of 533 patients with stage I-IIIA NSCLC.
• Multivariable Cox proportional hazards models and LASSO-penalized regression were used to assess the CALM index's association with OS.
• Performance metrics including C-index, iAUC, IDI, and decision-curve analysis were calculated.

Main Results:

• The CALM index emerged as a stable, independent predictor of OS in both conventional and LASSO-penalized models.
• The final model incorporating the CALM index, age, pathological stage, ASA status, pleural invasion, and modified Shine-Lal index demonstrated improved discrimination and risk reclassification at 3 and 5 years.
• Integration of the CALM index consistently increased net clinical benefit across various threshold probabilities.

Conclusions:

• The CALM index is a robust, accessible, and biologically plausible prognostic biomarker for resected stage I-IIIA NSCLC.
• It offers significant incremental prognostic value beyond traditional factors, aiding in refined prognostic stratification.
• Incorporating the CALM index into postoperative assessments supports more individualized clinical decision-making for NSCLC patients.