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