Prognostic Significance of the C-reactive Protein–Albumin–Lymphocyte (CALLY) Index in Oncologic Emergencies of Gastric Cancer: A Retrospective Cohort Study

Abstract Background Oncologic emergencies in gastric cancer, including bleeding, perforation, and malignant obstruction, require urgent intervention and are associated with severe inflammation, impaired nutritional status, and poor outcomes. Reliable prognostic indicators may help support therapeutic decision-making in these high-risk situations. This study evaluated the potential prognostic relevance of the C-reactive protein-albumin-lymphocyte (CALLY) index in patients undergoing surgery for gastric cancer-related emergencies. Methods A retrospective review was conducted of 397 patients who underwent gastrectomy between January 2016 and September 2024. Patients were classified into an Urgent group (U group; n=24), requiring hospitalization for preoperative bleeding, perforation, or malignant obstruction, and an Elective group (E group; n=373). Clinicopathological characteristics, perioperative outcomes, and overall survival were compared. The CALLY index was calculated from laboratory values obtained at admission, and its prognostic performance in the urgent cohort was explored using receiver operating characteristic (ROC) analysis. Results The U group had significantly more advanced clinical stages and a markedly lower R0 resection rate than the E group (70.8% vs. 96.0%; p < 0.001). Intraoperative blood loss was higher (470 vs. 50mL; p=0.004), and 30-day mortality was substantially greater in the U group (16.7% vs. 1.1%; p=0.0006). The 3-year overall survival was significantly poorer in the U group (52.8% vs. 83.5%; p < 0.001). Within the urgent cohort, a CALLY index < 1.2 was associated with lower R0 resection rate (41.7% vs. 91.6%; p=0.027) and poorer overall survival (p = 0.0063). ROC analysis suggested possible prognostic utility for 1-year survival prediction (AUC 0.96; 95% CI 0.86–0.99), although these findings should be interpreted cautiously given the limited sample size. Conclusions The CALLY index may provide complementary prognostic information reflecting systemic inflammatory and nutritional status in gastric cancer–related oncologic emergencies. Given the limited sample size and retrospective design, these findings should be interpreted as exploratory and hypothesis-generating, and require validation in larger multicenter studies.