The utility of the C-reactive protein-Albumin-Lymphocyte (CALLY) index in prognostic assessment of pancreatic head adenocarcinomas undergoing pancreaticoduodenectomy

Introduction and Objective: The systemic inflammatory response is widely recognized as a hallmark of cancer. Increasing evidence suggests that the systemic inflammatory response plays a critical role in cancer development, progression, and metastasis. Various preoperative inflammation-based prognostic markers have been reported to predict long-term survival in cancer patients. In this study, we aimed to investigate the prognostic significance of the CALLY index in patients with pancreatic head adenocarcinoma undergoing pancreaticoduodenectomy. Materials and Methods: In this study, we retrospectively analyzed the prospectively collected data of 101 patients who underwent pancreaticoduodenectomy for pancreatic head adenocarcinoma between 2010 and 2021 at Çukurova University Faculty of Medicine, Balcalı Hospital. The patients' demographic data, intraoperative and postoperative outcomes, pathological characteristics, prognostic factors, and survival rates were evaluated. Results: Patients were divided into two groups based on the cut-off value determined by ROC analysis, which was identified as 1.38. The low CALLY index group included 58 patients, while the high CALLY index group comprised 43 patients. Age was significantly lower in the high CALLY index group (p = 0.04). No significant differences were observed between the groups in terms of ASA score, BMI, CEA, and CA19-9 levels (p > 0.05). Additionally, there were no significant differences between the groups concerning the presence of preoperative ERCP with stent placement, preoperative percutaneous drainage, intraoperative transfusion requirements, postoperative transfusion needs, tumor size, total number of lymph nodes removed, or the number of metastatic lymph nodes (p > 0.05).However, intraoperative and postoperative complications, reoperation needs, unplanned hospital visits, and 30- and 90-day postoperative mortality rates were significantly higher in the low CALLY index group (p < 0.05). Three-year survival was also significantly lower in the low CALLY index group (p < 0.05). Conclusion: The CALLY index, calculated using serum CRP, albumin, and lymphocyte count, may be useful in predicting long-term outcomes in patients with pancreatic head adenocarcinoma undergoing pancreatoduodenectomy. Our findings suggest that the CALLY index could serve as a promising prognostic tool for stratifying these patients. However, further studies involving larger patient populations and multicenter trials are needed to validate its utility.