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Low CALLY Index Linked to Worse Survival in Lung Cancer, but Evidence Certainty Is LowNew blood marker may help predict lung cancer survival

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Key Takeaway
Interpret lower CALLY as a potential poor prognostic marker, but evidence certainty is low.

This meta-analysis synthesized data from cohort studies to evaluate the association between the C-reactive protein-albumin-lymphocyte (CALLY) index and survival outcomes in patients with primary lung malignancies. The analysis included 13 cohorts for overall survival (OS) and 8 cohorts for recurrence/progression-free survival (RFS/PFS).

Lower CALLY was associated with poorer OS (HR 1.78, 95% CI 1.49-2.12) and poorer RFS/PFS (HR 1.60, 95% CI 1.40-1.84). These associations suggest that a lower CALLY index may reflect an adverse prognostic profile, but the observational nature of the included studies precludes causal inference.

The authors rated the certainty of evidence as low for both OS and RFS/PFS due to risk of bias, heterogeneity, endpoint indirectness, and variation in biomarker measurement and endpoint definitions. No data on adverse events or tolerability were reported, as expected for a prognostic biomarker review.

Practice relevance is limited: while lower CALLY was associated with adverse survival outcomes, interpretation is restricted by methodological limitations and measurement variability. The CALLY index does not have established clinical utility based on this evidence, and it should not be considered a definitive predictor of mortality.

How this fits prior evidence

This meta-analysis extends prior coverage of prognostic and supportive care topics in lung cancer. Previous items addressed imaging (HSV-Net for nodule segmentation), radiation-related cardiac risk, and non-pharmacological symptom management (exercise for depressive symptoms, moxibustion/acupressure for fatigue, physical activity for functional capacity). In contrast, this review focuses on a laboratory-based inflammatory-nutritional index (CALLY) and its association with survival. The low certainty of evidence contrasts with the more definitive findings for some interventions covered earlier, underscoring that prognostic biomarker evidence in lung cancer remains limited by methodological heterogeneity.

When a patient is diagnosed with lung cancer, doctors look for every possible clue to understand the path ahead. One such clue might be a blood marker called the CALLY index. This index combines three different measurements from the blood to give a clearer picture of a patient's health status.

Researchers looked at data from several groups of patients with primary lung cancers. They found that a lower CALLY score was linked to poorer survival rates. Specifically, patients with lower scores were less likely to survive longer or stay cancer-free compared to those with higher scores.

While these results are interesting, the evidence is currently limited. Because the study combined many different groups, there was a lot of variation in how the markers were measured. Because of these inconsistencies, the certainty of the finding is currently low. It is an early sign that could help doctors, but more consistent research is needed.

What this means for you:
A lower CALLY blood marker is linked to shorter survival times in patients with lung cancer.

Common questions

What is the CALLY index?

The CALLY index is a blood marker that combines three different measurements: C-reactive protein, albumin, and lymphocytes. It is used to help researchers and doctors understand the health status of patients with lung cancer.

How does the CALLY index affect lung cancer outcomes?

The study found that a lower CALLY score was associated with poorer overall survival and shorter progression-free survival. This means patients with lower scores were less likely to survive longer or remain free from cancer progression.

Is this finding a certain way to predict survival?

Not yet. The certainty of this finding is currently low because of differences in how the markers were measured and the variety of patient groups involved. It shows a link, but it is not a definitive predictor of mortality.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedOct 2026
View Original Abstract ↓
Background: The C-reactive protein-albumin-lymphocyte (CALLY) index integrates systemic inflammation, nutritional status, and immune function. We evaluated its association with survival in primary lung malignancies. Methods: Embase, PubMed, Scopus, and Web of Science were searched from inception to 18 September 2026. Risk of bias was assessed using the Quality In Prognosis Studies tool. Hazard ratios (HRs) were synthesized using random-effects models with restricted maximum likelihood estimation and Hartung-Knapp adjustment. Sensitivity analyses, subgroup analyses, and meta-regression examined robustness and heterogeneity. Results: Eleven studies contributed 13 cohorts to the overall survival (OS) analysis and 8 cohorts from seven studies to a combined recurrence/progression-free survival (RFS/PFS) analysis. Lower CALLY was associated with poorer OS (HR 1.78, 95% CI 1.49-2.12; I2=71.6%) and poorer RFS/PFS (HR 1.60, 95% CI 1.40-1.84; I2=0%). Associations persisted in leave-one-out analyses. No statistically significant subgroup differences were detected. Funnel-plot asymmetry suggested small-study effects for OS and RFS/PFS. Seven studies had moderate and four had high overall risk of bias. The certainty of evidence was rated as low for both OS and RFS/PFS, primarily due to risk of bias, heterogeneity, and endpoint indirectness. Conclusion: Lower CALLY was associated with adverse survival outcomes in the current synthesis. Methodological limitations and variation in biomarker measurement and endpoint definitions restrict interpretation. Prospective validation using standardized measurements and clinically coherent outcomes is needed to establish incremental prognostic value and clinical utility. Keywords: CALLY index; lung cancer; prognosis; overall survival; systematic review; meta-analysis
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