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Low CALLY index is associated with worse progression-free survival and overall survival in renal cell carcinomaCALLY index helps predict survival for kidney cancer patients

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Key Takeaway
Note that a low CALLY index is associated with worse progression-free and overall survival in renal cell carcinoma.

This meta-analysis synthesized data from five retrospective cohort studies involving 587 patients with renal cell carcinoma to evaluate the prognostic value of the C-reactive protein-albumin-lymphocyte (CALLY) index. The analysis focused on progression-free survival (PFS) and overall survival (OS) as primary and secondary outcomes, respectively.

The meta-analysis found that a low CALLY index was associated with significantly worse outcomes. Specifically, a low CALLY index was associated with worse PFS (HR = 2.89; 95% CI: 1.82-4.58; I2 = 24.7%) and worse OS (HR = 2.32; 95% CI: 1.61-3.35; I2 = 0%).

Several limitations were noted, including the reliance on retrospective cohort studies and the presence of heterogeneous renal cell carcinoma populations. Notably, the prediction interval for progression-free survival included the null value (0.84-9.98). While the CALLY index may serve as an adjunctive prognostic biomarker, it does not have established stage-specific or treatment-specific effects. Clinical application should be interpreted with caution due to the observational nature of the source data.

How this fits prior evidence

This meta-analysis addresses a gap in identifying prognostic biomarkers for renal cell carcinoma. While previous evidence noted that progression-free survival and objective response rate are not reliable surrogates for overall survival in metastatic renal cell carcinoma, this finding suggests the CALLY index may provide additional prognostic information. However, the results remain observational and do not establish specific treatment-related outcomes.

Living with kidney cancer, known as renal cell carcinoma, brings many unknowns about how the disease will progress. Doctors are looking for better ways to predict how a patient might fare. A recent look at data from 587 patients suggests that a specific calculation called the CALLY index could offer more clarity. This index combines three different markers in the blood: C-reactive protein, albumin, and lymphocytes.

The analysis found that patients with a low CALLY index had a higher risk of their cancer progressing and a lower chance of overall survival. Specifically, a low score was linked to a much higher risk of the disease worsening. While this tool shows promise as a way to help predict outcomes, it is important to note that the data comes from several older studies rather than a single new clinical trial.

Because the patients in these studies were very different from one another, the results are not yet certain enough to say exactly how it affects specific stages of cancer or specific treatments. It is currently seen as a helpful extra piece of information for doctors to consider, rather than a definitive rule. Patients should talk with their oncology team to see how these markers might apply to their specific situation.

What this means for you:
A low CALLY blood marker score is linked to a higher risk of progression and worse survival in kidney cancer.

Common questions

What is the CALLY index and how does it work?

The CALLY index is a calculation that combines three different markers in the blood: C-reactive protein, albumin, and lymphocytes. In this study of 587 patients with renal cell carcinoma, researchers found that a low CALLY score was associated with worse progression-free survival and overall survival.

Can this test tell doctors exactly how a patient will respond to treatment?

Not yet. While the CALLY index may serve as a helpful extra tool for doctors to predict outcomes, the study did not show specific effects based on the stage of cancer or the specific type of treatment a patient received.

How reliable is this finding for kidney cancer patients?

The findings come from a meta-analysis of five retrospective studies. Because the patients in those studies were very different from one another, the results are not yet definitive. You should discuss these markers with your doctor to see how they apply to your specific case.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedOct 2026
View Original Abstract ↓
BackgroundThe C-reactive protein-albumin-lymphocyte (CALLY) index is a composite biomarker integrating systemic inflammation, nutritional status, and immune competence. Although its prognostic value has been investigated in several malignancies, its clinical relevance in renal cell carcinoma (RCC) remains incompletely defined. We conducted a systematic review and meta-analysis to evaluate the association between the CALLY index and survival outcomes in patients with RCC.MethodsPubMed and Embase were systematically searched from database inception to August 2026 for cohort studies evaluating the prognostic value of the CALLY index in RCC. Hazard ratios (HRs) and 95% confidence intervals (CIs) for progression-free survival (PFS) and overall survival (OS) were extracted and pooled using random-effects models. Subgroup analyses were performed according to the clinical populations represented by localized/clear cell RCC (ccRCC) and metastatic/mixed-histology RCC.ResultsFive retrospective cohort studies comprising 587 patients were included. Across clinically heterogeneous RCC populations, a low CALLY index was associated with worse PFS (pooled HR = 2.89, 95% CI: 1.82–4.58; I² = 24.7%) and OS (pooled HR = 2.32, 95% CI: 1.61–3.35; I² = 0%). The 95% prediction interval included the null value for PFS (0.84–9.98) but not for OS (1.30–4.17). Subgroup analyses comparing localized/ccRCC with metastatic/mixed-histology populations did not identify statistically significant differences between subgroups for PFS or OS.ConclusionA low CALLY index was associated with poorer PFS and OS across the heterogeneous RCC populations represented in the available retrospective studies. These findings support the potential role of CALLY as an adjunctive prognostic biomarker but do not establish stage-specific or treatment-specific effects. Prospective multicenter studies using standardized measurement protocols and externally validated cut-offs are needed to determine its incremental prognostic value and clinical utility.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420261484115, identifier CRD420261484115.
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