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Meta-Analysis
. 2025 Apr 11;25(1):672.
doi: 10.1186/s12885-025-14074-3.

Integrating inflammation, nutrition, and immunity: the CALLY index as a prognostic tool in digestive system cancers - a systematic review and meta-analysis

Bo Wu #  1 , Jingting Liu #  2 , Chaodan Shao  1 , Dongli Yu  1 , Jianhua Liao  3
Affiliations
Meta-Analysis

Integrating inflammation, nutrition, and immunity: the CALLY index as a prognostic tool in digestive system cancers - a systematic review and meta-analysis

Bo Wu et al. BMC Cancer. .

Abstract

Background: Digestive system cancers remain a leading cause of cancer-related mortality globally, underscoring the need for reliable prognostic tools. The C-reactive protein-Albumin-Lymphocyte (CALLY) index, which reflects inflammation, nutrition, and immunity, has shown potential in predicting survival. However, comprehensive evaluations of its role in digestive system cancers are still limited.

Methods: A meta-analysis of English-language studies from online databases was performed to assess the prognostic value of the CALLY index. Pooled hazard ratios (HRs) were calculated for overall survival (OS), disease-free survival (DFS), recurrence-free survival (RFS), and cancer-specific survival (CSS).

Results: A total of eighteen articles (19 studies, encompassing 7,951 patients) were included. A lower CALLY index was significantly associated with poorer outcomes across all survival endpoints. The pooled HR for OS was 1.973 (95% CI: 1.734-2.244), with HRs for DFS, RFS, and CSS being 2.093 (95% CI: 1.682-2.604), 1.462 (95% CI: 1.292-1.654), and 2.456 (95% CI: 1.887-3.221), respectively (all P < 0.001). Subgroup analyses for OS demonstrated consistent prognostic significance across various treatment strategies, cancer types, cutoff values, sample sizes, and regions. Notably, the CALLY index was a strong predictor of OS in surgical patients (HR = 2.014, 95% CI: 1.794-2.260, P < 0.001). Sensitivity analyses validated the robustness of these findings, with minimal publication bias (Egger's test P = 0.053).

Conclusions: The CALLY index serves as a cost-effective and reliable biomarker for predicting prognosis in digestive system cancers. Its utility as a pre-treatment risk stratification tool, which integrates key factors of inflammation, nutrition, and immunity, renders it valuable for guiding clinical decision-making.

Keywords: CALLY index; Digestive system cancers; Meta-analysis; Prognostic biomarker.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: As the data utilized in this study were derived exclusively from publicly available databases, ethical approval and informed consent were not required. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart for identifying relevant articles from the literature
Fig. 2
Fig. 2
Forest plots of overall survival in patients with digestive system cancers stratified by CALLY index levels
Fig. 3
Fig. 3
Forest plots of survival outcomes in patients with digestive system cancers: (a) Disease-Free Survival, (b) Recurrence-Free Survival, and (c) Cancer-Specific Survival Stratified by CALLY Index Levels
Fig. 4
Fig. 4
Sensitivity analysis of overall survival in patients with digestive system cancers
Fig. 5
Fig. 5
Assessment of publication bias in the included studies using Egger’s test
See this image and copyright information in PMC

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