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Prognostic significance of the CRP–albumin–lymphocyte (CALLY) index in esophageal cancer: systematic review and meta-analysis

evidence-based-medicine
gastroenterology-and-hepatology
oncology

Abstract

BACKGROUND AND OBJECTIVE: Esophageal cancer (EC) is associated with marked regional disparities, poor 5-year survival (15%–25%), and limited progress in therapeutic outcomes. The TNM staging system has reduced accuracy for long-term survival prediction, particularly after neoadjuvant therapy. The C-reactive protein – Albumin – Lymphocyte (CALLY) index—integrating inflammation (C-reactive protein), nutrition (albumin), and immunity (lymphocytes)—emerges as a novel prognostic biomarker. This study aims to evaluate its association with survival outcomes in patients with EC.

METHODS : Following the PRISMA guidelines and PROSPERO registration (CRD420251125031), two researchers independently screened and extracted data from all relevant original articles published from database inception to July 2025. Study quality was assessed using the NOS score. Meta-analysis was performed using RevMan 5.3 software, and the risk of bias was assessed using risk of bias plots and funnel plots.

RESULTS : Seven studies involving 2243 patients were included in this meta-analysis. Results revealed that the CALLY index was an independent prognostic factor for 5-year overall survival (OS) and recurrence-free survival (RFS) in univariate and multivariate analyses, and a high CALLY index was a favorable prognostic factor. Moreover, patients with EC in the high CALLY index group had better 5-year OS and RFS than those in the low CALLY index group.

CONCLUSION : The pretreatment CALLY index is a robust, independent prognostic biomarker for EC that significantly predicts improved OS and RFS.

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