Deciphering the potential of the C-reactive protein-albumin-lymphocyte index as a prognostic biomarker in malignancy: a systematic review and meta-analysis

Objective: The prognostic value of the pretreatment C-reactive protein-albumin-lymphocyte (CALLY) index for survival outcomes in patients with solid tumors is evaluated through a systematic review and meta-analysis. Methods: We conducted comprehensive searches in PubMed, EMBASE, Cochrane Library and Web of Science for all records published up to February 2026. Hazard ratios (HRs) with 95% confidence intervals (CIs) were retrieved. The associations between pretreatment CALLY and survival endpoints were synthesized using Stata 18.0 and Review Manager 5.4. Overall survival (OS) was the main endpoint; disease-free survival (DFS), progression-free survival (PFS), and recurrence-free survival (RFS) were also assessed. Results: Fifty-six reports (64 cohorts) comprising 26, 643 individuals were included. A higher CALLY index was correlated with superior OS (HR, 0.55; 95% CI, 0.50-0.60; P<0.00001), DFS (HR, 0.52; 95% CI, 0.46-0.58; P < 0.00001), PFS (HR, 0.39; 95% CI, 0.25-0.61; P<0.0001), and RFS (HR, 0.66; 95% CI, 0.60-0.72; P < 0.00001). Subgroup analyses revealed that effect estimates may be modified by sample size, follow-up duration, age, geographic region, CALLY cut-off values, cancer type, and tumor stage. Conclusions: A higher CALLY score is significantly associated with improved survival outcomes in patients with cancer, indicating its potential as a promising prognostic biomarker.