Real-World Evaluation of the HELPP Score and CALLY Index for Preoperative Prognostic Stratification in Resectable Pancreatic Ductal Adenocarcinoma

<b>Background/Objectives</b>: Preoperative prognostic assessment is essential for optimizing treatment strategies in pancreatic ductal adenocarcinoma (PDAC). This study aimed to evaluate and compare the prognostic value of the Heidelberg Pancreatic Prognostic (HELPP) score and the C-reactive protein-albumin-lymphocyte (CALLY) index in patients with resectable PDAC. <b>Methods</b>: We retrospectively analyzed clinical and laboratory data of 109 patients with resectable PDAC who underwent curative-intent surgery and adjuvant therapy. Patients were stratified based on preoperative HELPP and CALLY scores. Overall survival (OS) and disease-free survival (DFS) were assessed using Kaplan-Meier analysis, while independent prognostic factors were determined through multivariate Cox regression. <b>Results</b>: Kaplan-Meier survival analyses demonstrated that a HELPP score > 3 and a low CALLY index (≤1.029) were significantly associated with worse OS and DFS (log-rank <i>p</i> < 0.05). In multivariate analysis, the HELPP score was identified as an independent predictor of survival, whereas the CALLY index, although associated with survival in univariate analysis, did not reach statistical significance. In ROC analysis, both models exhibited acceptable discrimination, with the HELPP score achieving superior AUC values in predicting 1-year OS compared to the CALLY index. <b>Conclusions</b>: The HELPP score demonstrated independent prognostic value in multivariate analysis and may serve as a robust preoperative tool in resectable PDAC. The CALLY index, although not independently significant in multivariate analysis, showed strong prognostic separation in Kaplan-Meier survival analyses and may still aid in preoperative risk stratification, particularly where access to comprehensive scoring systems is limited.