Association between the preoperative C-reactive protein-albumin-lymphocyte index and prognosis after hepatic resection for hepatocellular carcinoma
- 1Department of Surgery, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital
Abstract
Background: Postoperative recurrence after hepatic resection for hepatocellular carcinoma (HCC) remains frequent. Readily available biomarkers that integrate host inflammatory, immune, and nutritional statuses may improve risk stratification. In this study, we evaluated the prognostic significance of the preoperative C-reactive protein (CRP)-albumin-lymphocyte (CALLY) index in patients who underwent resection for primary HCC. Methods: This retrospective, single-center study included 611 patients who underwent hepatic resection for primary HCC between 2004 and 2022. The CALLY index was defined as (albumin × lymphocytes)/(CRP × 104). Patients were classified into high (≥ 2.2) and low (< 2.2) CALLY index groups. Clinicopathological factors, disease-free survival (DFS), and overall survival (OS) were compared. Prognostic factors were assessed using Cox proportional hazards models, and propensity-score matching was performed. Results: The low CALLY index group had lower albumin levels, higher CRP and alpha-fetoprotein levels, larger tumors, and more severe postoperative complications than the high CALLY index group. Patients with low CALLY index had significantly worse DFS and OS than those with high CALLY index. Multivariate analysis identified that the low CALLY index was independently associated with worse DFS (hazard ratio (HR), 1.86; 95% confidence interval (CI), 1.40–2.47; P < 0.0001) and OS (HR, 1.93; 95% CI, 1.37–2.72; P = 0.0002). After propensity-score matching, the low CALLY index group continued to have significantly poorer DFS and OS rates than the high CALLY index group. Conclusions: The preoperative CALLY index was independently associated with DFS and OS after hepatic resection for primary HCC. This simple biomarker may help identify patients at a high risk of recurrence and poor survival.
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BibTeX
@article{shimagaki2026association,
title = {{Association between the preoperative C-reactive protein-albumin-lymphocyte index and prognosis after hepatic resection for hepatocellular carcinoma}},
author = {Tomonari Shimagaki and Atsushi Maeda and Tomoya Harima and Akihiro Sakai and Rumi Matono and Naotaka Hashimoto and Shohei Yamaguchi and Kozo Konishi and Kenkichi Hashimoto and Takashi Maeda},
journal = {PLOS One},
year = {2026},
month = sep,
doi = {10.1371/journal.pone.0358776},
url = {https://doi.org/10.1371/journal.pone.0358776},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Association between the preoperative C-reactive protein-albumin-lymphocyte index and prognosis after hepatic resection for hepatocellular carcinoma
AU - Tomonari Shimagaki
AU - Atsushi Maeda
AU - Tomoya Harima
AU - Akihiro Sakai
AU - Rumi Matono
AU - Naotaka Hashimoto
AU - Shohei Yamaguchi
AU - Kozo Konishi
AU - Kenkichi Hashimoto
AU - Takashi Maeda
PY - 2026
DA - 2026/09/30
JO - PLOS One
DO - 10.1371/journal.pone.0358776
UR - https://doi.org/10.1371/journal.pone.0358776
AB - Background: Postoperative recurrence after hepatic resection for hepatocellular carcinoma (HCC) remains frequent. Readily available biomarkers that integrate host inflammatory, immune, and nutritional statuses may improve risk stratification. In this study, we evaluated the prognostic significance of the preoperative C-reactive protein (CRP)-albumin-lymphocyte (CALLY) index in patients who underwent resection for primary HCC. Methods: This retrospective, single-center study included 611 patients who underwent hepatic resection for primary HCC between 2004 and 2022. The CALLY index was defined as (albumin × lymphocytes)/(CRP × 104). Patients were classified into high (≥ 2.2) and low (< 2.2) CALLY index groups. Clinicopathological factors, disease-free survival (DFS), and overall survival (OS) were compared. Prognostic factors were assessed using Cox proportional hazards models, and propensity-score matching was performed. Results: The low CALLY index group had lower albumin levels, higher CRP and alpha-fetoprotein levels, larger tumors, and more severe postoperative complications than the high CALLY index group. Patients with low CALLY index had significantly worse DFS and OS than those with high CALLY index. Multivariate analysis identified that the low CALLY index was independently associated with worse DFS (hazard ratio (HR), 1.86; 95% confidence interval (CI), 1.40–2.47; P < 0.0001) and OS (HR, 1.93; 95% CI, 1.37–2.72; P = 0.0002). After propensity-score matching, the low CALLY index group continued to have significantly poorer DFS and OS rates than the high CALLY index group. Conclusions: The preoperative CALLY index was independently associated with DFS and OS after hepatic resection for primary HCC. This simple biomarker may help identify patients at a high risk of recurrence and poor survival.
SN - 1932-6203
ER -