A CRP-Albumin-Lymphocyte (CALLY) Index–Based Nomogram for Predicting Survival After Radical Surgery for Hypopharyngeal Squamous Cell Carcinoma

Xiangli Meng,1 Jin Wang,1 Wei Shen,1 Shanshan Yang,1 Kelei Zhao,1 Xiaomei Liu,2 Kun Cheng,3 Lingling Tian,4 Hao Cheng,2,4 Xuelian Xu2 1Department of Oncology, the First Affiliated Hospital of Henan Medical University, Xinxiang, Henan, 453100, People’s Republic of China; 2Department of Radiotherapy Oncology, the First Affiliated Hospital of Henan Medical University, Xinxiang, Henan, 453100, People’s Republic of China; 3Department of Pharmacy, the First People’s Hospital of Shangqiu, Shangqiu, Henan, 476100, People’s Republic of China; 4Department of Radiotherapy Oncology, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, 450000, People’s Republic of ChinaCorrespondence: Hao Cheng, Email [email protected] Xuelian Xu, Email [email protected]: Hypopharyngeal squamous cell carcinoma (HSCC) is an aggressive malignancy associated with a notably poor prognosis. This study assessed the prognostic significance of the CRP-albumin-lymphocyte (CALLY) index for disease-free survival (DFS) and overall survival (OS) in postoperative HSCC patients, and constructed nomograms integrating the CALLY index and other independent predictors to enhance clinical applicability of individualized survival prediction.Methods: This multicenter retrospective study of 278 postoperative HSCC patients had a 3:1 training/validation split. Multivariate Cox regression analyses were performed to identify clinicopathological variables independently associated with DFS and OS. A predictive nomogram incorporating these significant prognostic factors was subsequently developed. Following a series of validations, a risk stratification system was established based on the risk scores within the model.Results: Multivariate Cox regression analysis identified the CALLY index, eastern cooperative oncology group performance status (ECOG PS), stage, surgical margin, extranodal extension (ENE), and the age-adjusted Charlson comorbidity index (ACCI) as independent prognostic predictors of both DFS and OS. Using these predictors, two clinicopathological nomograms were developed—one to estimate DFS, and another for OS. Validations demonstrated robust discriminative ability, with area under the curve (AUC) values consistently exceeding those of the conventional AJCC staging system. Furthermore, a risk stratification system was established based on the integrated nomogram-derived total risk score, categorizing patients into different subgroups. Notably, subgroup analysis revealed that adjuvant radiotherapy was associated with statistically significant survival benefits exclusively among high- and medium-risk patients; no clinically meaningful improvement in DFS or OS was observed in the low-risk group.Conclusion: For postoperative HSCC patients, CALLY index serves as a significant independent prognostic factor for DFS and OS. The nomograms developed by CALLY index and other clinicopathological variables outperforms the staging system. Adjuvant radiotherapy warrants caution in low-risk patients.Keywords: CRP-albumin-lymphocyte index, hypopharyngeal squamous cell carcinoma, nomogram, survival, risk stratification system