天津医药

天津医药 ›› 2025, Vol. 53 ›› Issue (9): 967-971.doi: 10.11958/20250589

• 临床研究 • 上一篇    下一篇

术前CALLY指数对根治性胃切除术患者短期预后的预测价值

高正杰(), 孟涛, 张俏, 陈炳合, 侯栋, 朱绍辉△()   

  1. 新乡医学院第一附属医院普通外科（邮编453100）
  • 收稿日期:2025-02-06 修回日期:2025-05-26 出版日期:2025-09-15 发布日期:2025-09-16
  • 通讯作者: △E-mail：z912zhu@163.com
  • 作者简介:高正杰（1986），男，主治医师，主要从事胃肠道肿瘤的基础与临床研究。E-mail：gzk333@163.com
  • 基金资助:
    河南省医学科技攻关计划联合共建项目(LHGJ20210523)

The predictive value of preoperative CALLY index for the short-term prognosis in patients undergoing radical gastrectomy

GAO Zhengjie(), MENG Tao, ZHANG Qiao, CHEN Binghe, HOU Dong, ZHU Shaohui△()   

  1. Department of General Surgery, the First Affiliated Hospital of Xinxiang Medical College, Xinxiang 453100, China
  • Received:2025-02-06 Revised:2025-05-26 Published:2025-09-15 Online:2025-09-16
  • Contact: △E-mail: z912zhu@163.com

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摘要：

目的 探讨术前C反应蛋白-白蛋白-淋巴细胞比值（CALLY指数）对根治性胃切除术患者短期预后的预测价值。方法 回顾性分析228例接受根治性胃切除术的胃癌患者临床资料及随访结果，根据随访结果将患者分为预后良好组（205例）和预后不良组（23例）。比较2组临床特征、实验室检查结果的差异。采用Cox比例风险回归模型分析CALLY指数对患者不良预后的影响。受试者工作特征（ROC）曲线获取CALLY指数预测患者预后不良的临床价值和最佳临界值。Kaplan-Meier法比较不同CALLY指数水平患者的无病生存期差异。结果 经过3~53个月的随访（中位随访36个月），23例预后不良中有3例死亡，20例复发或转移。2组相比，预后不良组的肿瘤更大、低分化比例更高，白细胞计数、中性粒细胞计数、C反映蛋白（CRP）升高，淋巴细胞、白蛋白、前白蛋白、总胆固醇和CALLY指数更低。多因素Cox回归分析显示，CALLY指数升高（HR=0.306，95%CI：0.102~0.921，P=0.035）是预后不良的独立保护因素，而肿瘤直径大、肿瘤低分化是预后不良的独立危险因素。ROC曲线分析结果显示，CALLY指数预测胃癌患者接受根治性胃切除术预后不良的曲线下面积为0.862（95%CI：0.810~0.904），敏感度为95.65%，特异度为69.76%，最佳临界值为2.21。K-M曲线分析结果显示，CALLY指数>2.21患者的无病生存期长于≤2.21的患者（平均无病生存时间：48个月vs. 42个月，Log-rank χ2=4.123，P=0.042）。结论 术前CALLY指数是一个简单、有效且易于获取的预测根治性胃切除术患者短期预后的指标，高CALLY指数提示患者预后较好。

关键词: 胃肿瘤, 复发, 预后, CALLY指数, 根治性切除术

Abstract:

Objective To explore the predictive value of the preoperative C-reactive protein-albumin-lymphocyte ratio (CALLY index) for short-term prognosis in patients undergoing radical gastrectomy. Methods The clinical data of 228 gastric cancer patients who underwent radical gastrectomy were retrospectively analyzed. Based on follow-up results, patients were divided into the good prognosis group (n=205) and the poor prognosis group (n=23). The differences in clinical characteristics and laboratory test results between the two groups were compared. Cox proportional hazards regression model was used to analyze the impact of CALLY index on poor prognosis in patients. The receiver operating characteristic (ROC) curve was used to determine the clinical value and optimal cutoff value of CALLY index in predicting poor prognosis of patients. Kaplan-Meier method was used to analyze the difference in disease-free survival (DFS) between patients with different CALLY index levels. Results After a follow-up of 3 to 53 months (median follow-up of 36 months), 23 patients developed poor prognosis (including 3 deaths and 20 recurrences or metastases). Compared with the good prognosis group, tumors in the poor prognosis group were larger, the proportion of poorly differentiated tumors was higher and white blood cell count (WBC), neutrophil count (NEU), C-reactive protein (CRP) were higher, and lymphocyte (LYM), albumin (ALB), prealbumin, total cholesterol (TC) and CALLY indexl were lower. Multivariate Cox regression analysis showed that the elevated CALLY index (HR=0.306, 95%CI: 0.102-0.921, P=0.035) was an independent protective factor for poor prognosis, while larger tumors and poorly differentiated tumors were independent risk factors for poor prognosis. ROC curve analysis showed that the area under the curve for predicting poor prognosis in gastric cancer patients undergoing radical gastrectomy was 0.862 (95%CI: 0.810-0.904), with a sensitivity of 95.65%, specificity of 69.76%, and an optimal cutoff value of 2.21. Kaplan-Meier analysis showed that patients with a CALLY index > 2.21 had a longer disease-free survival than those with a CALLY index ≤2.21 (mean DFS: 48 months vs. 42 months, Log-rank χ2=4.123, P=0.042). Conclusion The preoperative CALLY index is a simple, effective and easily accessible predictor for predicting short-term prognosis in patients undergoing radical gastrectomy. A high CALLY index indicates a better prognosis of patient.

Key words: stomach neoplasms, recurrence, prognosis, CALLY indexs, radical resection

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