ArticleFrontiers in nutrition2026
Which immunonutritional marker best predicts disease-free survival in non-metastatic colorectal Cancer? The CALLY index and CAR emerge as independent predictors from a seven-marker comparison.
Article in Frontiers in nutrition, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Many immunonutritional markers (INMs) have emerged as significant prognostic indicators in colorectal cancer (CRC); however, limited attention has been given to directly comparing these candidates to identify the most informative predictors. Methods: We retrospectively analyzed 414 patients with stage I-III CRC who underwent curative resection. Seven INMs, including the C-reactive protein-albumin-lymphocyte (CALLY) index, the C-reactive protein-to-albumin ratio (CAR), and five other markers, were evaluated. The primary outcome was disease-free survival (DFS). Multivariable Cox proportional hazards regression was performed to identify independent predictors of DFS. The discriminatory performance of the resulting models was quantified using Harrell's concordance index (C-index). Results: In univariable analysis, all seven INMs were significantly associated with DFS. However, after adjusting for T and N stages and other covariates, only the CALLY index (HR, 1.686; 95% confidence interval (CI), 1.038-2.738; Conclusion: The CALLY index and CAR were the only INMs that retained independent prognostic significance after adjustment for T and N stages. Incorporating these continuous markers into the Tumor-Node-Metastasis (TNM) staging system substantially improved risk stratification and predictive accuracy in patients with non-metastatic CRC.
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