Preoperative C-reactive protein albumin lymphocyte (CALLY) index assessment predicted disease-free survival and overall survival in patients with hepatocellular carcinoma (HCC) undergoing hepatic resection, according to a retrospective study of 611 patients.
Researchers evaluated the prognostic value of the CALLY index in patients who underwent hepatic resection for primary hepatocellular carcinoma between 2004–2022. The index integrates albumin, lymphocyte count, and C-reactive protein levels to reflect nutritional, immune, and inflammatory status.
Patients were categorised into high CALLY index (≥2.2) and low CALLY index (<2.2) groups, and outcomes were assessed using survival analyses and propensity score matching.
Patients with a low CALLY index demonstrated less favourable clinical characteristics than those with a high index.
Survival analyses showed significantly worse disease-free survival and overall survival among patients with a low CALLY index. Low CALLY index remained independently associated with poorer disease-free survival: (hazard ratio: 1.86; 95% CI: 1.40–2.47; p<0.0001). It was also independently associated with worse overall survival: (hazard ratio: 1.93; 95% CI: 1.37–2.72; p=0.0002).
The association persisted after propensity score matching. Even in the matched cohort, patients with a low CALLY index experienced significantly poorer disease-free and overall survival than those with a high index.
Sensitivity analyses further demonstrated that the relationship between low CALLY index and adverse outcomes remained consistent across both treatment eras examined.
Researchers concluded that the CALLY index may provide clinically useful information when combined with established tumour and liver function factors.
However, since it showed modest prognostic discrimination from overall survival it should not be interpreted as a stand-alone prognostic tool. Rather, it may serve as an adjunctive biomarker that complements established tumour- and liver-related factors. Further studies are needed to determine whether the CALLY index improves discrimination and clinical decision-making when added to comprehensive prognostic models.
Reference
Shimagaki T et al. Association between the preoperative C-reactive protein-albumin-lymphocyte index and prognosis after hepatic resection for hepatocellular carcinoma. PLoS One. 2026. DOI:10.1371/ journal.pone.0358776.
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