Utility of the C-Reactive Protein-Albumin-Lymphocyte (CALLY) Index in Prognostic Assessment of Pancreatic Head Adenocarcinomas Undergoing Pancreaticoduodenectomy.

Background and Objectives: Systemic inflammation, nutritional status, and host immune response play pivotal roles in cancer progression and patient prognosis. The C-reactive protein-albumin-lymphocyte (CALLY) index is a novel inflammation-based biomarker integrating these parameters. This study aimed to evaluate the prognostic value of the preoperative CALLY index in patients undergoing pancreaticoduodenectomy for pancreatic head adenocarcinoma. Materials and Methods: This retrospective study included 101 consecutive patients who underwent pancreaticoduodenectomy with curative intent for histopathologically confirmed pancreatic head adenocarcinoma at Çukurova University Faculty of Medicine between 2010 and 2021. Demographic, clinicopathological, perioperative, and survival data were analyzed. The CALLY index was calculated using preoperative serum C-reactive protein, albumin, and lymphocyte levels, and the optimal cutoff value was determined by receiver operating characteristic (ROC) curve analysis. Results: Using an optimal cutoff value of 1.38, patients were categorized into low (n = 58) and high (n = 43) CALLY index groups. Patients with a low CALLY index experienced significantly higher rates of intraoperative and postoperative complications, surgical site infection, reoperation, unplanned hospital readmissions, and 30- and 90-day mortality (all p < 0.05). Moreover, the low CALLY index group demonstrated significantly poorer overall survival than the high CALLY index group (p < 0.001). Receiver operating characteristic (ROC) analysis for overall mortality yielded an area under the curve (AUC) of 0.701 (95% CI, 0.591-0.811). On multivariable Cox regression, a low CALLY index remained an independent predictor of poorer overall survival (adjusted hazard ratio [aHR], 2.45; 95% CI, 1.47-4.08; p < 0.001) after adjustment for age, tumor size, lymph node status, resection margin, and differentiation. On multivariable logistic regression, a low CALLY index was independently associated with surgical site infection (adjusted odds ratio [aOR], 11.5; 95% CI, 3.9-34.2; p < 0.001) and overall postoperative morbidity (aOR, 5.3; 95% CI, 2.0-14.0; p < 0.001). Conclusions: The preoperative C-reactive protein-albumin-lymphocyte (CALLY) index is a simple, inexpensive, and readily available biomarker with significant prognostic value in patients undergoing pancreaticoduodenectomy for pancreatic head adenocarcinoma. A low CALLY index was associated with poorer overall survival and increased postoperative morbidity and mortality. The CALLY index may serve as a practical tool for preoperative risk stratification and prognostic assessment. However, prospective multicenter studies are warranted to validate standardized cutoff values and further establish its clinical applicability.