C-Reactive Protein-Albumin-Lymphocyte Index (Cally) As A Prognostic Biomarker in Colorectal Cancer: A Systematic Review
Main Article Content
Globally, colorectal cancer is ranked as the third highest incidence of cancer and the second highest cause of death; therefore, it is in dire need of prognostic markers that can be implemented in health facilities. The C-reactive protein-albumin-lymphocyte (CALLY) index is a biomarker that uses the values of CRP, albumin, and lymphocyte counts, which have been utilized to predict the prognosis of various diseases, including colorectal cancer. The research involved a thorough search of several databases, such as PubMed, Science Direct, and Google Scholar, from 2018 to 2025. The journal search strategy began with the determination of research questions using PICO. This study applied inclusion and exclusion criteria to refine the journal searches. A significant increase in the CALLY index predicts a reduced risk of death. The CALLY index has a higher prognostic value than other prognostic factors for colorectal cancer. Stage II-III colorectal cancer patients with a low pre-operative CALLY index have a significantly worse prognosis. Lower CALLY values are associated with a poorer prognosis of colorectal cancer. A prospective multicenter study with a larger and more diverse population is needed to validate the findings of this study.
Keywords:
Colorectal cancer, Incidence of cancer, C-reactive protein
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Li, J., Zhang, Y., & Zhang, Q. (2021). Dysbiosis and chronic inflammation in the pathogenesis of colorectal cancer: A review. Journal of Cancer Research and Clinical Oncology, 147(9), 2565-2573.
Zhang, L., Liu, Z., & Huang, R. (2020). C-reactive protein-albumin-lymphocyte index as a prognostic marker in cancer: A systematic review. Cancer Biomarkers, 28(1), 12-23.
Thanikachalam K, Khan G. Colorectal Cancer and Nutrition. Nutrients. 2019 Jan 14; 11(1):164. doi: 10.3390/nu11010164. PMID: 30646512; PMCID: PMC6357054.
Quaglio AEV, Grillo TG, De Oliveira ECS, Di Stasi LC, Sassaki LY. Gut microbiota, inflammatory bowel disease and colorectal cancer. World J Gastroenterol. 2022 Aug 14; 28(30):4053-4060. doi: 10.3748/wjg.v28.i30.4053. PMID: 36157114; PMCID: PMC9403435.
Siegel RL, Jakubowski CD, Fedewa SA, Davis A, Azad NS. Colorectal Cancer in the Young: Epidemiology, Prevention, Management. Am Soc Clin Oncol Educ Book. 2020 Mar;40:1-14. doi: 10.1200/EDBK_279901. PMID: 32315236.
Dekker E, Tanis PJ, Vleugels JLA, Kasi PM, Wallace MB. Colorectal cancer. Lancet. 2019 Oct 19; 394(10207):1467-1480. doi: 10.1016/S0140-6736(19)32319-0. PMID: 31631858.
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Suzuki S, Akiyoshi T, Oba K, Otsuka F, Tominaga T, Nagasaki T, Fukunaga Y, Ueno M. Comprehensive Comparative Analysis of Prognostic Value of Systemic Inflammatory Biomarkers for Patients with Stage II/III Colon Cancer. Ann Surg Oncol. 2020 Mar; 27(3):844-852. doi: 10.1245/s10434-019-07904-9. Epub 2019 Nov 12. PMID: 31720937.
Golder AM, McMillan DC, Park JH, Mansouri D, Horgan PG, Roxburgh CS. The prognostic value of combined measures of the systemic inflammatory response in patients with colon cancer: an analysis of 1700 patients. Br J Cancer. 2021 May; 124(11):1828-1835. doi: 10.1038/s41416-021-01308-x. Epub 2021 Mar 24. PMID: 33762720; PMCID: PMC8144393.
Zhuang J, Wang S, Wang Y, Wu Y, Hu R. Prognostic Value of CRP-Albumin-Lymphocyte (CALLY) Index in Patients Undergoing Surgery for Breast Cancer. Int J Gen Med. 2024 Mar 15;17:997-1005. doi: 10.2147/IJGM. S447201. PMID: 38505146; PMCID: PMC10949993.
Tsai YT, Ko CA, Chen HC, Hsu CM, Lai CH, Lee YC, Tsai MS, Chang GH, Huang EI, Fang KH. Prognostic Value of CRP-Albumin-Lymphocyte (CALLY) Index in Patients Undergoing Surgery for Oral Cavity Cancer. J Cancer. 2022 Jul 27; 13(10):3000-3012. doi: 10.7150/jca.74930. PMID: 36046647; PMCID: PMC9414026.
Wang W, Gu J, Liu Y, Liu X, Jiang L, Wu C, Liu J. Pre-Treatment CRP-Albumin-Lymphocyte Index (CALLY Index) as a Prognostic Biomarker of Survival in Patients with Epithelial Ovarian Cancer. Cancer Manag Res. 2022 Sep 19;14:2803-2812. doi: 10.2147/CMAR. S359968. PMID: 36160036; PMCID: PMC9504533.
Iida H, Tani M, Komeda K, Nomi T, Matsushima H, Tanaka S, Ueno M, Nakai T, Maehira H, Mori H, Matsui K, Hirokawa F, Kaibori M, Kubo S. Superiority of CRP-albumin-lymphocyte index (CALLY index) as a non-invasive prognostic biomarker after hepatectomy for hepatocellular carcinoma. HPB (Oxford). 2022 Jan; 24(1):101-115. doi: 10.1016/j.hpb.2021.06.414. Epub 2021 Jun 22. PMID: 34244053.
Meng P, Gu T, Xu J, Huang H, Jin H, Wang Y, Zhang H, Ruan Z. 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 May 21;16:1605067. doi: 10.3389/fimmu.2025.1605067. PMID: 40469280; PMCID: PMC12133803.
Hirata H, Fujii N, Oka S, Nakamura K, Shimizu K, Kobayashi K, Hiroyoshi T, Isoyama N, Shiraishi K. C-reactive Protein-albumin-lymphocyte Index as a Novel Biomarker for Progression in Patients Undergoing Surgery for Renal Cancer. Cancer Diagn Progn. 2024 Nov 3; 4(6):748-753. doi: 10.21873/cdp.10391. PMID: 39502622; PMCID: PMC11534045.
Hashimoto I, Tanabe M, Onuma S, Morita J, Nagasawa S, Maezawa Y, Kanematsu K, Aoyama T, Yamada T, Yukawa N, Ogata T, Rino Y, Saito A, Oshima T. Clinical Impact of the C-reactive Protein-albumin-lymphocyte Index in Post-gastrectomy Patients With Gastric Cancer. In Vivo. 2024 Mar-Apr; 38(2):911-916. doi: 10.21873/invivo.13518. PMID: 38418120; PMCID: PMC10905428.
Wu B, Liu J, Shao C, Yu D, Liao J. 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 Apr 11; 25(1):672. doi: 10.1186/s12885-025-14074-3. PMID: 40217204; PMCID: PMC11992890.
Takeda Y, Sugano H, Okamoto A, Nakano T, Shimoyama Y, Takada N, Imaizumi Y, Ohkuma M, Kosuge M, Eto K. Prognostic usefulness of the C-reactive protein-albumin-lymphocyte (CALLY) index as a novel biomarker in patients undergoing colorectal cancer surgery. Asian J Surg. 2024 Aug; 47(8):3492-3498. doi: 10.1016/j.asjsur.2024.03.054. Epub 2024 Mar 26. PMID: 38538400.
Bekki T, Shimomura M, Yano T, Watanabe A, Ishikawa S, Imaoka K, Ono K, Matsubara K, Mochizuki T, Hattori M, Akabane S, Ohdan H. C-reactive Protein-albumin-lymphocyte Index Is a Useful Indicator for Recurrence and Survival Following Curative Resection of Stage I-III Colorectal Cancer. J Anus Rectum Colon. 2025 Apr 25; 9(2):192-201. doi: 10.23922/jarc.2024-070. PMID: 40302855; PMCID: PMC12035343.
Furukawa S, Hiraki M, Kimura N, Kohya N, Sakai M, Ikubo A, Samejima R. The Potential of the C-Reactive Protein-Albumin-Lymphocyte (CALLY) Index as a Prognostic Biomarker in Colorectal Cancer. Cancer Diagn Progn. 2025 May 3; 5(3):370-377. doi: 10.21873/cdp.10449. PMID: 40322216; PMCID: PMC12046663.
Yang M, Lin SQ, Liu XY, Tang M, Hu CL, Wang ZW, Zhang Q, Zhang X, Song MM, Ruan GT, Zhang XW, Liu T, Xie HL, Zhang HY, Liu CA, Zhang KP, Li QQ, Li XR, Ge YZ, Liu YY, Chen Y, Zheng X, Shi HP. Association between C-reactive protein-albumin-lymphocyte (CALLY) index and overall survival in patients with colorectal cancer: From the investigation on nutrition status and clinical outcome of common cancers study. Front Immunol. 2023 Mar 30;14:1131496. doi: 10.3389/fimmu.2023.1131496. PMID: 37063910; PMCID: PMC10098202.
Li, J., Zhang, Y., & Zhang, Q. (2021). Dysbiosis and chronic inflammation in the pathogenesis of colorectal cancer: A review. Journal of Cancer Research and Clinical Oncology, 147(9), 2565-2573.
Zhang, L., Liu, Z., & Huang, R. (2020). C-reactive protein-albumin-lymphocyte index as a prognostic marker in cancer: A systematic review. Cancer Biomarkers, 28(1), 12-23.
