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. 2023 Mar 30:14:1131496.
doi: 10.3389/fimmu.2023.1131496. eCollection 2023.

Association between C-reactive protein-albumin-lymphocyte (CALLY) index and overall survival in patients with colorectal cancer: From the investigation on nutrition status and clinical outcome of common cancers study

Ming Yang  1   2   3   4 , Shi-Qi Lin  1   2   3   4   5 , Xiao-Yue Liu  1   2   3   4 , Meng Tang  1   2   3   4 , Chun-Lei Hu  1   2   3   4 , Zi-Wen Wang  1   2   3   4 , Qi Zhang  1   2   3   4 , Xi Zhang  1   2   3   4 , Meng-Meng Song  1   2   3   4 , Guo-Tian Ruan  1   2   3   4 , Xiao-Wei Zhang  1   2   3   4 , Tong Liu  1   2   3   4 , Hai-Lun Xie  1   2   3   4 , He-Yang Zhang  1   2   3   4 , Chen-An Liu  1   2   3   4 , Kang-Ping Zhang  1   2   3   4 , Qin-Qin Li  1   2   3   4 , Xiang-Rui Li  1   2   3   4 , Yi-Zhong Ge  1   2   3   4   5 , Yu-Ying Liu  1   2   3   4 , Yue Chen  1   2   3   4   5 , Xin Zheng  1   2   3   4 , Han-Ping Shi  1   2   3   4
Affiliations

Association between C-reactive protein-albumin-lymphocyte (CALLY) index and overall survival in patients with colorectal cancer: From the investigation on nutrition status and clinical outcome of common cancers study

Ming Yang et al. Front Immunol. .

Abstract

Background: Colorectal cancer (CRC) is among the most common malignant cancers worldwide, and its development is influenced by inflammation, nutrition, and the immune status. Therefore, we combined C-reactive protein (CRP), albumin, and lymphocyte, which could reflect above status, to be the CRP-albumin-lymphocyte (CALLY) index, and evaluated its association with overall survival (OS) in patients with CRC.

Methods: The clinicopathological and laboratory characteristics of 1260 patients with CRC were collected from the Investigation on Nutrition Status and Clinical Outcome of Common Cancers (INSCOC) study. Cox regression analysis was performed to assess the association between the CALLY index and OS. A nomogram including sex, age, the CALLY index and TNM stage was constructed. The Concordance Index (C-index) was utilized to evaluate the prognostic value of the CALLY index and classical CRC prognostic factors, such as modified Glasgow prognostic score (mGPS), neutrocyte to lymphocyte ratio (NLR), systemic immune inflammation index (SII), and platelet to lymphocyte ratio (PLR), as well as to assess the prognostic value of the nomogram and TNM stage.

Results: Multivariate Cox regression analyses demonstrated that the CALLY index was independently associated with OS in patients with CRC [Hazard ratio (HR) = 0.91, 95% confidence interval (CI) = 0.87-0.95, P<0.001]. The CALLY index showed the highest prognostic value (C-index = 0.666, 95% CI = 0.638-0.694, P<0.001), followed by mGPS, NLR, SII, and PLR. The nomogram demonstrated higher prognostic value (C-index = 0.784, 95% CI = 0.762-0.807, P<0.001) than the TNM stage.

Conclusion: The CALLY index was independently associated with OS in patients with CRC and showed higher prognostic value than classical CRC prognostic factors. The nomogram could provide more accurate prognostic prediction than TNM stage.

Keywords: colorectal cancer; immune; inflammation; nutrition; prognosis.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Procedures for selection of study participants with CRC from the INSCOC study. CRC, colorectal cancer; INSCOC, Investigation on Nutrition Status and Clinical Outcome of Common Cancers; CRP, C-reactive protein.
Figure 2
Figure 2
Association between the CALLY index and OS in patients with CRC in different stratifications including sex (men vs. women), age (less than 65 years vs. 65 years or more), BMI (less than 24 kg/m2 vs. 24 kg/m2 or more), smoking status (Yes vs. No), alcohol consumption (Yes vs. No), PG-SGA (less than 4 vs. 4 or more), tumor stage (I/II/III vs. IV), and KPS (less than 90 vs. 90 or more). Models were adjusted for sex, age, BMI, smoking status, alcohol consumption, TNM stage, KPS and PG-SGA, but not adjusted for the stratification variable. HR, Hazard ratio; CI, confidence interval; BMI, body mass index; KPS, Karnofsky performance status score; PG-SGA, Scored Patient-Generated Subjective Global Assessment; CALLY, C-reactive protein-albumin-lymphocyte; OS, overall survival; CRC, colorectal cancer.
Figure 3
Figure 3
AUC of the CALLY index and classical CRC prognostic factors in patients with CRC. AUC, area under the ROC curve; ROC, receiver operating characteristic; CALLY, C-reactive protein-albumin-lymphocyte; CRC, colorectal cancer; mGPS, modified Glasgow prognostic score; NLR, neutrocyte to lymphocyte ratio; SII, systemic immune inflammation index; PLR, platelet to lymphocyte ratio.
Figure 4
Figure 4
A proposed nomogram for predicting median survival time and survival probability in patients with CRC. Sex, age, the CALLY index and TNM stage were included in the constructed nomogram. To use the nomogram, a line is drawn upward to the Points axis to determine the number of points received for each variable. Sum of these points makes the total points. For total points, a line is drawn from the Total Points axis downward to the survival axes to determine the estimated median survival time and survival probability. CRC, colorectal cancer; CALLY, C-reactive protein-albumin-lymphocyte.
Figure 5
Figure 5
AUCs of the nomogram and the TNM stage in patients with CRC. AUC, area under the ROC curve; ROC, receiver operating characteristic; CRC, colorectal cancer.
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