The CALLY Index for Unresectable or Recurrent Gastric Cancer Treated With Nivolumab: A Multicenter Retrospective Study

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Purpose: The C-reactive protein-albumin-lymphocyte (CALLY) index is a novel immunonutritional marker in various cancers.We investigated its prognostic value in patients with unresectable or recurrent gastric cancer who were treated with nivolumab monotherapy. Materials and Methods:This multicenter retrospective study included 126 patients treated with third-or later-line nivolumab monotherapy.The CALLY index was calculated as (Albumin × Lymphocyte Count)/(C-Reactive Protein × 10 4 ) and dichotomized at 1.08.The operating characteristics of this cutoff were evaluated using receiver operating characteristic analysis for 1-year overall survival (OS).OS and progression-free survival (PFS) were evaluated.Results: The CALLY-low group exhibited a significantly shorter median OS (164 vs. 377 days; P=0.004) and median PFS (56 vs. 104 days; P<0.001) than the CALLY-high group.In multivariable models from which posttreatment immune-related adverse events were excluded, the CALLY index was an independent prognostic factor for both OS (hazard ratio [HR], 2.05; 95% confidence interval [CI], 1.31-3.21;P=0.002) and PFS (HR, 2.00; 95% CI, 1.33-3.02;P<0.001) after adjustment for clinically relevant factors.Conclusions: The pretreatment CALLY index was an independent prognostic biomarker for both OS and PFS in patients with unresectable or recurrent gastric cancer receiving third-or later-line nivolumab monotherapy.By integrating the C-reactive protein levels, albumin levels, and lymphocyte counts, the CALLY index may serve as a practical tool for pretreatment risk stratification in this setting.

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