Clinical and prognostic significance of the C-reactive protein-albumin-lymphocyte (CALLY) index in breast cancer: a systematic review and meta-analysis
Listed in
This article is not in any list yet, why not save it to one of your lists.Abstract
Background
The C-reactive protein–albumin–lymphocyte (CALLY) index integrates inflammatory, nutritional and immune-related biomarkers and may offer an accessible measure of host status in breast cancer. However, its prognostic relevance and clinical value remain uncertain. This systematic review and meta-analysis evaluated its associations with survival and treatment response and examined predictive performance.
Methods
PubMed, Embase, Scopus and Web of Science were searched from inception to 1 October 2026, supplemented by reference-list and forward-citation searching. Studies evaluating CALLY in adults with invasive breast cancer were eligible. Multivariable-adjusted hazard ratios (HRs) comparing low versus high baseline CALLY were pooled using restricted maximum likelihood random-effects models with modified Hartung–Knapp intervals. Risk of bias and evidence certainty were assessed using the Newcastle–Ottawa Scale and GRADE, respectively.
Results
Nine publications included 2,568 reported patients. Four studies comprising 1,394 patients contributed to each survival synthesis. Low CALLY yielded pooled HRs of 2.03 for overall survival (95% CI 1.20-3.45; I²=72.4%) and 2.00 for disease-free survival (95% CI 0.91–4.41; I²=77.7%). Both intervals included no association. In one HER2-positive cohort, low baseline CALLY was associated with lower odds of pathological complete response (adjusted OR 0.25, 95% CI 0.12–0.50). Apparent overall-survival area under the receiver-operating-characteristic curve (AUC) ranged from 0.688 to 0.740. External validation and demonstrated clinical utility were absent.
Conclusions
CALLY shows potential prognostic and treatment-response associations, but imprecision, heterogeneity and limited validation prevent routine clinical adoption. Standardized measurement, prospective validation and demonstration of incremental clinical value are needed.
