Immunonutritive Scoring for Patients with Hepatocellular Carcinoma Undergoing Transarterial Chemoembolization: Evaluation of the CALLY Index

Abstract

The novel CRP–albumin–lymphocyte (CALLY) index is an improved immunonutritive scoring system, based on serum C-reactive protein (CRP), serum albumin, and the lymphocyte count. It has shown promise as a prognostic index for patients with hepatocellular carcinoma (HCC) undergoing resections. This study evaluated the prognostic ability of the CALLY index for patients with HCC undergoing transarterial chemoembolization (TACE). We retrospectively identified 280 treatment-naïve patients with HCC that underwent an initial TACE at our institution, between 2010 and 2020. We compared the CALLY index to established risk factors in univariate and multivariate regression analyses for associations with median overall survival (OS). A low CALLY score was associated with low median OS (low vs. high CALLY: 9.0 vs. 24.0 months, p < 0.001). In the multivariate analysis, the CALLY index remained an independent prognostic predictor (p = 0.008). Furthermore, all factors of the CALLY index reached significance in univariate and in-depth multivariate analyses. However, the concordance index (C-index) of the CALLY index (0.60) was similar to the C-indices of established immunonutritive and inflammation scoring systems (range: 0.54 to 0.63). In conclusion, the CALLY index showed promise as a stratification tool for patients with HCC undergoing TACE. Notably, the CALLY index was not superior to other immunonutritive and inflammation scoring systems in predicting the median OS. Thus, future studies should re-evaluate the mathematical calculation of the index, particularly the contributions of individual parameters.

The inflammatory burden index is a superior systemic inflammation biomarker for the prognosis of non‐small cell lung cancer

“…Table 1 summarizes the formulas used to calculate these biomarkers. These included previously reported existing and unevaluated systemic inflammation biomarkers 11,18–20 …”

“…These included previously reported existing and unevaluated systemic inflammation biomarkers. 11,[18][19][20] These systemic inflammation biomarkers were independently associated with OS in this cohort, except for lymphocyte-to-CRP ratio and platelet-to-lymphocyte ratio (Table S2). We found that, among these systemic inflammation biomarkers, the IBI had the highest C-statistic for predicting the prognosis of patients with NSCLC, reaching 0.640 (0.617, 0.663).…”

Local and Regional Therapies for Hepatocellular Carcinoma and Future Combinations

“…Thus, current attempts try to include novel risk factors to improve the predictive performance of risk scoring systems. In particular, the knowledge on the interplay of tumor development and progression as well as immune response and inflammatory reaction has been growing continuously [55][56][57][58][59]. Especially the role of neutrophils for HCC development and progression on the tumor microenvironment as well as in systemic reaction is under investigation.…”

“…Overview on currently applied immune-and inflammation based prognostic indices in patients with HCC undergoing TACE. Modified according to[57].…”

Pre-Treatment CRP-Albumin-Lymphocyte Index (CALLY Index) as a Prognostic Biomarker of Survival in Patients with Epithelial Ovarian Cancer

“…Indeed, the CALLY index has only been reported as a novel prognostic index in hepatocellular carcinoma. 17,18 However, the prognostic value of CALLY index in patients with EOC after surgery is not well explored.…”