De Novo metastatik kolorektal kanserde CALLY indeksinin prognostik değeri: retrospektif bir çalışma

Abstract

Aims: The CALLY index, integrating C-reactive protein (CRP), albumin, and lymphocyte count, has been identified as a promising prognostic biomarker in various cancers. The present study aims to evaluate its prognostic significance in De Novo metastatic colorectal cancer (mCRC). Methods: A retrospective analysis was conducted on 108 patients diagnosed with de novo mCRC at Ankara Etlik City Hospital (2021–2024). The CALLY index was calculated from baseline laboratory values and dichotomized at the median (0.2018). Progression-free survival (PFS) and overall survival (OS) were compared between low and high CALLY groups using the Kaplan–Meier method and log-rank test. The associations between the CALLY index and tumour location, as well as RAS/BRAF mutation status, were evaluated using the chi-square test. Cox regression analyses were also performed to determine independent prognostic factors. Results: Patients with elevated CALLY scores exhibited significantly prolonged median PFS (24.0 vs. 13.0 months; p<0.001) and OS (not reached vs. 15.0 months; p<0.001) in comparison to those with low scores. Low CALLY scores were found to be associated with RAS mutations (p=0.03) and tumour location (p=0.04), but not BRAF mutations (p=0.37). In multivariate Cox regression analysis, a high CALLY score remained an independent prognostic factor for both PFS and OS. Conclusion: A low CALLY index is associated with shorter durations of PFS and OS in patients harboring RAS mutations and right-sided tumour location. Its simplicity and practicality suggest considerable promise for routine clinical use, pending confirmation in large prospective studies.

Keywords

• CALLY index
• metastatic colorectal cancer
• RAS mutation
• prognosis

Prognostic value of the CALLY index in De Novo metastatic colorectal cancer: a retrospective study

Abstract

Aims: The CALLY index, integrating C-reactive protein (CRP), albumin, and lymphocyte count, has been identified as a promising prognostic biomarker in various cancers. The present study aims to evaluate its prognostic significance in De Novo metastatic colorectal cancer (mCRC). Methods: A retrospective analysis was conducted on 108 patients diagnosed with de novo mCRC at Ankara Etlik City Hospital (2021–2024). The CALLY index was calculated from baseline laboratory values and dichotomized at the median (0.2018). Progression-free survival (PFS) and overall survival (OS) were compared between low and high CALLY groups using the Kaplan–Meier method and log-rank test. The associations between the CALLY index and tumour location, as well as RAS/BRAF mutation status, were evaluated using the chi-square test. Cox regression analyses were also performed to determine independent prognostic factors. Results: Patients with elevated CALLY scores exhibited significantly prolonged median PFS (24.0 vs. 13.0 months; p<0.001) and OS (not reached vs. 15.0 months; p<0.001) in comparison to those with low scores. Low CALLY scores were found to be associated with RAS mutations (p=0.03) and tumour location (p=0.04), but not BRAF mutations (p=0.37). In multivariate Cox regression analysis, a high CALLY score remained an independent prognostic factor for both PFS and OS. Conclusion: A low CALLY index is associated with shorter durations of PFS and OS in patients harboring RAS mutations and right-sided tumour location. Its simplicity and practicality suggest considerable promise for routine clinical use, pending confirmation in large prospective studies.

Keywords

• CALLY index
• metastatic colorectal cancer
• RAS mutation
• prognosis

References

1. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209-249. doi:10. 3322/caac.21660
2. Jones RP, Kokudo N, Folprecht G, Fenwick SW, Poston GJ. Colorectal liver metastases: a critical review of state of the art. Liver Cancer. 2016; 6(1):66-71. doi:10.1159/000449348
3. Sivananthan A, Patel K, Kelly A, Machover D, Chau I. Metastatic colorectal cancer: epidemiology, treatment and survival in a contemporary population-based cohort. Cancer Treat Res Commun. 2024;38:100669. doi:10.1016/j.ctarc.2023.100669
4. Miller KD, Siegel RL, Lin CC, Mariotto AB, Kramer JL, Rowland JH. Cancer treatment and survivorship statistics, 2016. CA Cancer J Clin. 2016;66(4):271-289. doi:10.3322/caac.21349
5. Güç ZG. HALP score: a simple and easily accessible index for predicting prognosis in colorectal cancer patients. Genel Tıp Dergisi. 2022;32(5): 577-582. doi:10.54005/geneltip.1133890
6. McMillan DC. Systemic inflammation, nutritional status and survival in patients with cancer. Curr Opin Clin Nutr Metab Care. 2009;12(3):223-226. doi:10.1097/MCO.0b013e32832a7902
7. Jiang H, Li H, Li A, et al. Preoperative combined hemoglobin, albumin, lymphocyte and platelet levels predict survival in patients with locally advanced colorectal cancer. Oncotarget. 2016;7(44):72076-72083. doi:10. 18632/oncotarget.12271
8. Iida H, Matsuyama R, Ueda K, Shibutani M, Maeda K, Nagahara H. Clinical impact of the C-reactive protein/albumin/lymphocyte (CALLY) index in hepatocellular carcinoma patients undergoing hepatectomy. HPB (Oxford). 2022;24(1):101-115. doi:10.1016/j.hpb.2021.06.002

9. Feng J, Wang L, Yang X, Chen Q. Clinical significance of preoperative CALLY index for prognostication in patients with esophageal squamous cell carcinoma undergoing surgery. Sci Rep. 2024;14:713. doi:10.1038/s41598-023-50960-7
10. Acar C, Yüksel HÇ, Şahin G, Sarıoğlu S, Koca D. Prognostic utility of the CALLY index in metastatic melanoma: building a nomogram for patients on anti-PD-1 therapy. Clin Transl Oncol. 2025:1-11. doi:10.1007/s12094-025-03888-z
11. Furukawa S, Hiraki M, Kimura N, et al. The potential of the C-reactive protein-albumin-lymphocyte (CALLY) index as a prognostic biomarker in colorectal cancer. Cancer Diagn Progn. 2025;5(3):370-377. doi:10. 21873/cdp.10449
12. Douillard JY, Siena S, Cassidy J, et al. Final results from PRIME: randomized phase III study of panitumumab with FOLFOX4 for first-line treatment of metastatic colorectal cancer. Ann Oncol. 2014;25(7): 1346-1355. doi:10.1093/annonc/mdu141
13. Tuomisto AE, Mäkinen MJ, Väyrynen JPJWjog. Systemic inflammation in colorectal cancer: underlying factors, effects, and prognostic significance. World J Gastroenterol. 2019;25(31):4383-4404. doi:10.3748/wjg.v25.i31.4383
14. Grivennikov SI, Greten FR, Karin M. Immunity, inflammation, and cancer. Cell. 2010;140(6):883-899. doi:10.1016/j.cell.2010.01.025
15. Li MX, Liu XM, Zhang XF, et al. Prognostic role of neutrophil-to-lymphocyte ratio in colorectal cancer: a systematic review and meta-analysis. Int J Cancer. 2014;134(10):2403-2413. doi:10.1002/ijc.28536
16. Templeton AJ, McNamara MG, Šeruga B, et al. Prognostic role of neutrophil-to-lymphocyte ratio in solid tumors: a systematic review and meta-analysis. J Natl Cancer Inst. 2014;106(6):dju124. doi:10.1093/jnci/dju124
17. Lee GH, Malietzis G, Askari A, et al. Is right-sided colon cancer different from left-sided colorectal cancer? A systematic review. Eur J Surg Oncol. 2015;41(3):300-308. doi:10.1016/j.ejso.2014.11.001
18. Tamas K, Walenkamp AM, de Vries EG, van Vugt MA, Beets-Tan RG, van Eijck CH. Rectal and colon cancer: not just a different anatomic site. Cancer Treat Rev. 2015;41(8):671-679. doi:10.1016/j.ctrv.2015.06.007
19. Dasari A, Morris VK, Allegra CJ, et al. ctDNA applications and integration in colorectal cancer: an NCI Colon and Rectal–Anal Task Forces whitepaper. Nat Rev Clin Oncol. 2020;17(12):757-770. doi:10.1038/s41571-020-0392-0
20. Dogan E, Cengiz M, Bozkurt O, Inanc M, Ozkan MJA. Impact of clinicopathological features on prognosis in KRAS mutant metastatic colorectal cancer. Age. 2025;63(1):30-85. doi:10.4999/uhod.257981