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Published on: April 22, 2019
The CALLY Index for Unresectable or Recurrent Gastric Cancer Treated With Nivolumab: A Multicenter Retrospective
Kenji Takeshita1, Muneharu Fujisaki2, Motohiro Shionozaki3
1Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan. ken.take0817@gmail.com.
Purpose:
The C-reactive protein-albumin-lymphocyte (CALLY) index is a novel immuno-nutritional marker in various cancers. We investigated its prognostic value in patients with unresectable or recurrent gastric cancer who were treated with nivolumab monotherapy.
Materials And Methods:
This multicenter retrospective study included 126 patients treated with third- or later-line nivolumab monotherapy. The CALLY index was calculated as (Albumin × Lymphocyte Count)/(C-Reactive Protein × 10⁴) and dichotomized at 1.08. The operating characteristics of this cutoff were evaluated using receiver operating characteristic analysis for 1-year overall survival (OS). OS and progression-free survival (PFS) were evaluated.
Results:
The CALLY-low group exhibited a significantly shorter median OS (164 vs. 377 days; P=0.004) and median PFS (56 vs. 104 days; P<0.001) than the CALLY-high group. In multivariable models from which posttreatment immune-related adverse events were excluded, the CALLY index was an independent prognostic factor for both OS (hazard ratio [HR], 2.05; 95% confidence interval [CI], 1.31-3.21; P=0.002) and PFS (HR, 2.00; 95% CI, 1.33-3.02; P<0.001) after adjustment for clinically relevant factors.
Conclusions:
The pretreatment CALLY index was an independent prognostic biomarker for both OS and PFS in patients with unresectable or recurrent gastric cancer receiving third- or later-line nivolumab monotherapy. By integrating the C-reactive protein levels, albumin levels, and lymphocyte counts, the CALLY index may serve as a practical tool for pretreatment risk stratification in this setting.
