Prognostic significance of the C-reactive protein-albumin-lymphocyte (CALLY) index in primary lung malignancies: a systematic review and meta-analysis with GRADE assessment
- 1Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran
Abstract
BackgroundThe 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.
MethodsEmbase, 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.
ResultsEleven 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; I{superscript 2}=71.6%) and poorer RFS/PFS (HR 1.60, 95% CI 1.40-1.84; I{superscript 2}=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.
ConclusionLower 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.
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BibTeX
@misc{shamohammadi2026prognostic,
title = {{Prognostic significance of the C-reactive protein-albumin-lymphocyte (CALLY) index in primary lung malignancies: a systematic review and meta-analysis with GRADE assessment}},
author = {M. Shamohammadi and D. Yarahmadi and F. Naseri Rad and I. Patel and M. Yarahmadi and A. Rashidi and A. Yarahmadi and P. Kordestani Moghadam and N. Naghavi},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.18.26365819},
url = {https://www.medrxiv.org/content/10.64898/2026.10.18.26365819v1},
note = {CC BY-NC-ND},
}
RIS
TY - UNPB
TI - Prognostic significance of the C-reactive protein-albumin-lymphocyte (CALLY) index in primary lung malignancies: a systematic review and meta-analysis with GRADE assessment
AU - M. Shamohammadi
AU - D. Yarahmadi
AU - F. Naseri Rad
AU - I. Patel
AU - M. Yarahmadi
AU - A. Rashidi
AU - A. Yarahmadi
AU - P. Kordestani Moghadam
AU - N. Naghavi
PY - 2026
DA - 2026/10/18
PB - medRxiv
DO - 10.64898/2026.10.18.26365819
UR - https://www.medrxiv.org/content/10.64898/2026.10.18.26365819v1
AB - BackgroundThe 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. MethodsEmbase, 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. ResultsEleven 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; I{superscript 2}=71.6%) and poorer RFS/PFS (HR 1.60, 95% CI 1.40-1.84; I{superscript 2}=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. ConclusionLower 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.
ER -