Association between C-reactive protein-albumin-lymphocyte index and overall survival in patients with esophageal cancer

Background: Esophageal cancer is an aggressive malignant tumor with poor prognosis, making early detection and treatment crucial. C-reactive protein-albumin-lymphocyte (CALLY) index is a comprehensive indicator which is involved in the process of metabolism, inflammation and immune reaction, and has been addressed to correlate with clinical outcomes in cancer patients. However, However, the evidence in esophageal cancer remains unclear. This study aims to investigate the association between CALLY index and overall survival of patients with esophageal cancer.

Methods: This study includes the clinical characteristics of 518 patients with esophageal cancer from the Investigation on Nutrition Status and Clinical Outcome of Common Cancers (INSCOC) project, and evaluates the correlation between CALLY index and overall survival by COX regression analysis. Time-patient survival trends are verified using Kaplan-Meier method, and cubic spline function. Based on the results of multivariate Cox analysis, a nomogram showing 1, 2, 3, and 5-year survival rates is constructed. Calibration curve and decision curve analysis are used to evaluate the prediction accuracy and practical value of nomogram survival prediction. TNM staging of patients with esophageal cancer is determined according to the pathological examination results of the tumor and surrounding tissues, including the size and depth of the tumor (T), the involvement of lymph nodes (N), and the distant metastasis (M).

Results: Multivariate Cox regression analysis demonstrates that CALLY index (HR:0.967, 0.937-0.997, P < 0.05), smoking (HR: 1.592, 1.064-2.380, P < 0.05), TNM staging (HR: 1.595, 1.120-2.270, P < 0.05) are independent prognostic factors for survival of patients with esophageal cancer. Patients with high CALLY index has the lower risk of death than those with low CALLY index (HR: 0.54, 0.36-0.80, P < 0.05). The nomogram model including CALLY index shows better prediction ability than traditional TNM staging system.

Conclusion: CALLY index is independently positive associated with overall survival in patients with esophageal cancer and nomogram model displays superiority over TMN staging in predicting overall survival.