Prognostic significance of the CALLY index for cancer risk and survival: evidence from NHANES 2001-2018.

BACKGROUND

The C-reactive protein-albumin-lymphocyte (CALLY) index is an immune-nutritional biomarker associated with cancer prognosis. Its relevance to cancer incidence and long-term survival in the general population has not been well established.

METHODS

We analyzed NHANES 2001-2018 data from 36,904 participants, including 3,218 cancer patients. Logistic regression assessed cancer risk, and Cox proportional hazards models evaluated all-cause, cancer-specific, and cardiovascular mortality among cancer survivors. Restricted cubic splines (RCS) examined nonlinear associations, and subgroup analyses were stratified by age and sex.

RESULTS

Cancer patients showed lower CALLY index values. Compared with the lowest quartile, the highest quartile was associated with a reduced risk of cancer (OR = 0.77, 95% CI = 0.67-0.90, P < 0.001). RCS identified a nonlinear association with cancer incidence (P-nonlinearity = 0.003), with a threshold at 9.402 (log-transformed). Among survivors, higher CALLY index values were significantly associated with reduced all-cause (HR = 0.39), cancer-cause mortality (HR = 0.36), and cardiovascular mortality (HR = 0.32), all P < 0.001. These associations remained consistent across subgroups.

CONCLUSIONS

The CALLY index is significantly associated with cancer risk and mortality. As a simple and robust biomarker reflecting immune-nutritional status, it may be associated with cancer risk and could provide useful information for prognostic assessment. Although causal inferences cannot be drawn due to the cross-sectional design of NHANES.