What question did this study set out to answer?

The aim is to evaluate the prognostic value of the CALLY index for survival outcomes in solid tumors.

April 26, 2026Open Access

Deciphering the potential of the C-reactive protein-albumin-lymphocyte index as a prognostic biomarker in malignancy: a systematic review and meta-analysis

Key Points

The aim is to evaluate the prognostic value of the CALLY index for survival outcomes in solid tumors.
Conducted systematic review and meta-analysis of records published up to February 2026.
Analyzed hazard ratios (HRs) and 95% confidence intervals (CIs) using Stata 18.0 and Review Manager 5.4.
Main endpoint was overall survival, with additional assessments of disease-free, progression-free, and recurrence-free survival.
Higher CALLY index correlated with superior overall survival (HR, 0.55; 95% CI, 0.50-0.60; P<0.00001).
Also associated with better disease-free survival (HR, 0.52; 95% CI, 0.46–0.58; P<0.00001).
Notable improvements in progression-free survival (HR, 0.39; 95% CI, 0.25-0.61; P<0.0001) and recurrence-free survival (HR, 0.66; 95% CI, 0.60-0.72; P<0.00001).

Abstract

Objective The prognostic value of the pretreatment C-reactive protein–albumin–lymphocyte (CALLY) index for survival outcomes in patients with solid tumors is evaluated through a systematic review and meta-analysis. Methods We conducted comprehensive searches in PubMed, EMBASE, Cochrane Library and Web of Science for all records published up to February 2026. Hazard ratios (HRs) with 95% confidence intervals (CIs) were retrieved. The associations between pretreatment CALLY and survival endpoints were synthesized using Stata 18.0 and Review Manager 5.4. Overall survival (OS) was the main endpoint; disease-free survival (DFS), progression-free survival (PFS), and recurrence-free survival (RFS) were also assessed. Results Fifty-six reports (64 cohorts) comprising 26, 643 individuals were included. A higher CALLY index was correlated with superior OS (HR, 0.55; 95% CI, 0.50-0.60; P0.00001), DFS (HR, 0.52; 95% CI, 0.46–0.58; P 0.00001), PFS (HR, 0.39; 95% CI, 0.25-0.61; P0.0001), and RFS (HR, 0.66; 95% CI, 0.60-0.72; P 0.00001). Subgroup analyses revealed that effect estimates may be modified by sample size, follow-up duration, age, geographic region, CALLY cut-off values, cancer type, and tumor stage. Conclusions A higher CALLY score is significantly associated with improved survival outcomes in patients with cancer, indicating its potential as a promising prognostic biomarker.

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