HEPATOLOGY / CLINICAL RESEARCH
The C-reactive protein–albumin–lymphocyte (CALLY) index is associated with survival after radical resection of hepatitis B virus-related hepatocellular carcinoma: a propensity score-matched analysis in a Chinese cohort
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1
Department of Hepatology, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China
2
Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China
Submission date: 2026-01-23
Final revision date: 2026-04-23
Acceptance date: 2026-05-15
Online publication date: 2026-07-25
Corresponding author
Jinfeng Kong
Mengchao Hepatobiliary
Hospital of Fujian
Medical University
Chin
Yongyi Zeng
Mengchao Hepatobiliary
Hospital of Fujian
Medical University
Chin
Kunyu Ke
Mengchao Hepatobiliary
Hospital of Fujian
Medical University
Chin
KEYWORDS
TOPICS
ABSTRACT
Introduction:
The C-reactive protein–albumin–lymphocyte (CALLY) index has emerged as a promising prognostic tool in various malignancies, yet its role in patients with hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) remains underexplored. This study aimed to evaluate the association between the preoperative CALLY index and survival outcomes following radical resection in Chinese patients with HBV-related HCC.
Material and methods:
In this retrospective cohort study, we included 789 Chinese patients with HBV-related HCC who underwent radical resection. Recurrence free survival (RFS) and overall survival (OS) were assessed using Kaplan–Meier analysis. Multivariable Cox regression and propensity score matching (PSM) were employed to identify independent prognostic factors and address potential confounding.
Results:
The CALLY index was identified as an independent prognostic factor for both RFS and OS. Compared with the low-CALLY group, the high-CALLY group demonstrated significantly longer 1-, 3-, and 5-year RFS (96.3%, 65.7%, and 43.8% vs. 95.3%, 57.6%, and 35.0%, respectively; p = 0.014) and OS (98.5%, 91.0%, and 66.6% vs. 97.9%, 89.4%, and 56.9%; p = 0.008). These differences remained statistically significant following propensity score matching (PSM) adjustment.
Conclusions:
A high preoperative CALLY index is associated with improved survival after radical resection in patients with HBV-related HCC, supporting its utility as an easily accessible prognostic biomarker for clinical risk stratification.
REFERENCES (38)
1.
Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2024; 74: 229-63.
2.
Xia C, Dong X, Li H, et al. Cancer statistics in China and United States, 2022: profiles, trends, and determinants. Chin Med J 2022; 135: 584-90.
3.
Korean Liver Cancer Association (KLCA) and National Cancer Center (NCC) Korea. 2022 KLCA-NCC Korea Practice Guidelines for the Management of Hepatocellular Carcinoma. Korean J Radiol 2022; 23: 1126-240.
4.
Nwude VN, Lesi OA, Onyekwere C, et al. Clinical characteristics of hepatitis b virus-associated hepatocellular carcinoma patients in Southwest Nigeria. Pathogens 2025; 14: 169.
5.
Lin J, Zhang H, Yu H, et al. Epidemiological characteristics of primary liver cancer in Mainland China from 2003 to 2020: a representative multicenter study. Front Oncol 2022; 12: 906778.
6.
Singal AG, Llovet JM, Yarchoan M, et al. AASLD practice guidance on prevention, diagnosis, and treatment of hepatocellular carcinoma. Hepatology 2023; 78: 1922-65.
7.
Yang F, Ma L, Yang Y, et al. Contribution of Hepatitis B virus infection to the aggressiveness of primary liver cancer: a clinical epidemiological study in Eastern China. Front Oncol 2019; 9: 370.
8.
Tanemura A, Noguchi D, Shinkai T, et al. Prognostic significance of early and multiple recurrences after curative resection for hepatocellular carcinoma. BMC Surg 2024; 24: 339.
9.
Famularo S, Donadon M, Cipriani F, et al. Hepatocellular carcinoma surgical and oncological trends in a national multicentric population: the HERCOLES experience. Updates Surg 2020; 72: 399-411.
10.
Bakrim S, Fessikh ME, Elhrech H, et al. Targeting inflammation in cancer therapy: from mechanistic insights to emerging therapeutic approaches. J Transl Med 2025; 23: 588.
11.
Akkız H, Şimşek H, Balcı D, et al. Inflammation and cancer: molecular mechanisms and clinical consequences. Front Oncol 2025; 15: 1564572.
12.
Lu JN, Zhou LS, Zhang S, et al. Performance of nutritional and inflammatory markers in patients with pancreatic cancer. World J Clin Oncol 2024; 15: 1021-32.
13.
Ding Pa, Yang J, Wu J, et al. Combined systemic inflammatory immune index and prognostic nutrition index as chemosensitivity and prognostic markers for locally advanced gastric cancer receiving neoadjuvant chemotherapy: a retrospective study. BMC Cancer 2024; 24: 1014.
14.
Liu QW, Liu L, Hu JX, et al. Nomogram based on a novel nutritional immune-inflammatory status score to predict postoperative outcomes in esophageal squamous cell carcinoma. World J Gastroenterol 2025; 31: 101749.
15.
Zhao H, Wu J, Wu Q, et al. Systemic immune-inflammation index values are associated with non-melanoma skin cancers: evidence from the National Health and Nutrition Examination Survey 2010-2018. Arch Med Sci 2024; 20: 1128-37.
16.
Chen D, Ma Y, Li J, et al. Prognostic and clinicopathological significance of C-reactive protein–albumin–lymphocyte (CALLY) in patients with digestive system neoplasms: a systematic review and meta-analysis. World J Surg Oncol 2025; 23: 114.
17.
Wu B, Liu J, Shao C, et al. Integrating inflammation, nutrition, and immunity: the CALLY index as a prognostic tool in digestive system cancers – a systematic review and meta-analysis. BMC Cancer 2025; 25: 672.
18.
Sun Y, Sun Q, Zheng C, et al. C-reactive protein-albumin-lymphocyte (CALLY) index in chronic kidney disease and mortality: insights into inflammation, nutrition, and immune status. Arch Med Sci 2026; 22: 1389-98.
19.
Liu G, Zhao S, Xia M, et al. The CALLY index as a comprehensive inflammation-nutrition-immunity marker for prognosis in gastric cancer surgery. Surg Endosc 2026; 40: 3812-24.
20.
Ishizuka C, Imaizumi K, Ichikawa N, et al. The CALLY index as a predictive biomarker for the prognosis and treatment outcomes of colorectal cancer. Surg Today 2026; 56: 1470-9.
21.
Meng P, Gu T, Xu J, et al. Pretreatment CALLY index as promising novel biomarker in the prediction of surgical and oncological outcomes in esophageal cancer: a multi-center retrospective cohort study. Front Immunol 2025; 16: 1605067.
22.
Zhu L, Kong Y, Xing Y, et al. The prognostic and early efficacy prediction value of baseline C-reactive protein-albumin-lymphocyte (CALLY) index in advanced pancreatic cancer. Int J General Med 2025; 18: 3363-72.
23.
Xi P, Huang G, Huang K, et al. The prognostic significance of the CALLY index in ampullary carcinoma: an inflammation-nutrition retrospective analysis. J Inflam Res 2025; 18: 621-35.
24.
Zhang H, Shi J, Xie H, et al. Superiority of CRP-albumin-lymphocyte index as a prognostic biomarker for patients with gastric cancer. Nutrition 2023; 116: 112191.
25.
Jia P, Shen F, Zhao Q, et al. Association between C-reactive protein-albumin-lymphocyte index and overall survival in patients with esophageal cancer. Clin Nutr 2025; 45: 212-22.
26.
Iida H, Tani M, Komeda K, et al. Superiority of CRP-albumin-lymphocyte index (CALLY index) as a non-invasive prognostic biomarker after hepatectomy for hepatocellular carcinoma. Hpb 2022; 24: 101-15.
27.
Müller L, Hahn F, M Hringer-Kunz A, et al. Immunonutritive scoring for patients with hepatocellular carcinoma undergoing transarterial chemoembolization: evaluation of the CALLY Index. Cancers 2021; 13: 5018.
28.
Zhao H, Yin B, Li X, et al. The CRP-albumin-lymphocyte index provides enhanced prognostic value in liver cancer compared to the TNM staging system. Sci Rep 2025; 15: 20090.
29.
Kim ES, Kim SY, Moon A. C-reactive protein signaling pathways in tumor progression. Biomolecules Ther 2023; 31: 473-83.
30.
Okumura T, Kimura T, Iwadare T, et al. Prognostic significance of C-reactive protein in lenvatinib-treated unresectable hepatocellular carcinoma: a multi-institutional study. Cancers 2023; 15: 5343.
31.
Lin KY, Chen QJ, Tang SC, et al. Prognostic implications of alpha-fetoprotein and C-reactive protein elevation in hepatocellular carcinoma following resection (PACE): a large cohort study of 2770 patients. BMC Cancer 2023; 23: 1190.
32.
Wang X, Xu J, Zhang H, Qu P. The effect of albumin and hemoglobin levels on the prognosis of early-stage cervical cancer: a prospective, single-center–based cohort study. BMC Women’s Health 2023; 23: 553.
33.
Kuhlmann AD, Spies C, Schulte E, et al. Preoperative hypoalbuminaemia in liver surgery: an observational study at a university medical centre. BMJ Open 2023; 13: e068405.
34.
Ning J, Wang Y, Tao Z. The complex role of immune cells in antigen presentation and regulation of T-cell responses in hepatocellular carcinoma: progress, challenges, and future directions. Front Immunol 2024; 15: 1483834.
35.
Liu X, Qiu Z, Ndhlovu E, et al. Establishing and Externally Validating a Hemoglobin, Albumin, Lymphocyte, and Platelet (HALP) score-based nomogram for predicting early recurrence in BCLC stage 0/A hepatocellular carcinoma patients after radical liver resection: a multi-center study. J Hepatocell Carcin 2024; 11: 1127-41.
36.
Calder PC, Ortega EF, Meydani SN, et al. Nutrition, immunosenescence, and infectious disease: an overview of the scientific evidence on micronutrients and on modulation of the gut microbiota. Adv Nutr 2022; 13: S1-26.
37.
Zhu D, Lin YD, Yao YZ, et al. Negative association of C-reactive protein-albumin-lymphocyte index (CALLY index) with all-cause and cause-specific mortality in patients with cancer: results from NHANES 1999–2018. BMC Cancer 2024; 24: 1499.
38.
Wang S, Liu C, Zheng X, et al. Prognostic value of the C-reactive protein-albumin-lymphocyte index in cancer patients with sarcopenia: a study on overall survival. Nutrition 2025; 140: 112893.