# The C-reactive Protein-Albumin-Lymphocyte Index Predicts Survival Outcomes in Esophageal Cancer: A Meta-Analysis

## TL;DR

A new biomarker called the CALLY index can predict survival outcomes in esophageal cancer patients based on inflammation, nutrition, and immune function.

## Contribution

The study introduces the CALLY index as a novel composite biomarker and demonstrates its prognostic value in esophageal cancer.

## Key findings

- Higher CALLY index values are associated with significantly better overall survival in esophageal cancer patients.
- The CALLY index is also linked to improved disease-free survival with consistent results across studies.
- The biomarker shows potential for risk stratification and personalized treatment planning in esophageal cancer.

## Abstract

The C-reactive protein-albumin-lymphocyte (CALLY) index represents a novel composite biomarker integrating systemic inflammation, nutritional status, and immune function. This systematic review and meta-analysis aimed to evaluate the prognostic significance of the CALLY index in esophageal cancer patients. A comprehensive literature search was conducted across multiple databases from inception to August 2025, identifying studies that investigated the association between the CALLY index and survival outcomes in histologically confirmed esophageal cancer patients. The majority of studies employed retrospective cohort designs, with three being single-center studies and two utilizing multi-center approaches. The studies were conducted between 2024 and 2025, with four originating from Asian populations and one from a Western population. Meta-analysis revealed that patients with higher CALLY index values experienced significantly better overall survival compared to those with lower values (risk ratio (RR): 2.24, 95% CI: 1.71-2.94, p<0.001), despite moderate heterogeneity (I²=62%). Similarly, a higher CALLY index was associated with improved disease-free survival (RR: 1.99, 95% CI: 1.65-2.40, p<0.001) with no heterogeneity observed (I²=0%). Sensitivity analyses confirmed the robustness of these findings. The CALLY index demonstrates significant prognostic value in esophageal cancer, with lower values indicating worse outcomes. This composite biomarker may serve as a valuable tool for risk stratification and treatment planning, potentially guiding personalized therapeutic approaches. However, standardization of cut-off values and validation through prospective studies are needed to establish its clinical utility.