{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T16:06:04Z","timestamp":1790697964150,"version":"4.1.0"},"reference-count":29,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: The CRP\u2013albumin\u2013lymphocyte (CALLY) index is promoted both as a marker of postoperative morbidity and as a prognostic factor for survival. These claims are rarely tested together, thresholds usually come from the dataset in which they are then tested, and the index is seldom compared against its components. We examined both in one minimally invasive esophagectomy cohort. Methods: Consecutive esophagectomies with a thoracoscopic or robotic thoracic phase at one centre were reviewed. The index was derived from the preoperative albumin, C-reactive protein, and lymphocyte count. Short-term endpoints were major morbidity (Clavien\u2013Dindo grade \u2265 3) and anastomotic leak; survival was analysed by Kaplan\u2013Meier and Cox methods, with internal cut-points stress-tested by bootstrapping. Results: Of 154 esophagectomies screened, 22 open or transhiatal procedures and one exploration without resection were excluded, leaving 131 patients. Major morbidity occurred in 39 (29.8%), and leak in 21 (16.0%). The index discriminated neither: area under the curve 0.556 (95% CI: 0.450\u20130.663) and 0.481 (95% CI: 0.339\u20130.623). Over a median follow-up of 31.0 months, there were 39 deaths, and median survival was 62.1 months. Here, the index behaved differently: each unit of log-CALLY carried a hazard ratio of 0.776 (95% CI: 0.643\u20130.936, p = 0.008), and three-year survival rose from 48.5% in the lowest tertile to 77.1% in the highest (trend p = 0.020). The association held after adjustment for stage and nodal status (0.749, 95% CI: 0.609\u20130.922, p = 0.006), lifting the concordance index of a stage-based model from 0.699 to 0.741. However, entered with CRP, the index lost significance. Conclusions: The index said nothing useful about early surgical morbidity yet was independently associated with survival, although that signal did not survive adjustment for CRP alone. It belongs with prognostic markers rather than perioperative risk scores.<\/jats:p>","DOI":"10.3390\/jcm15197567","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T15:14:37Z","timestamp":1790694877000},"page":"7567","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Preoperative CRP\u2013Albumin\u2013Lymphocyte (CALLY) Index Is Associated with Survival but Does Not Predict Anastomotic Leak or Major Morbidity After Minimally Invasive Esophagectomy"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8815-5220","authenticated-orcid":false,"given":"\u00d6mer","family":"\u00c7a\u011fl\u0131yan","sequence":"first","affiliation":[{"name":"Department of Gastroenterological Surgery, Ba\u015fak\u015fehir \u00c7am and Sakura City Hospital, 34480 Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6894-6896","authenticated-orcid":false,"given":"Yi\u011fit","family":"D\u00fczk\u00f6yl\u00fc","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological Surgery, Ba\u015fak\u015fehir \u00c7am and Sakura City Hospital, 34480 Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erdal","family":"Karak\u00f6se","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological Surgery, Ba\u015fak\u015fehir \u00c7am and Sakura City Hospital, 34480 Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8860-0630","authenticated-orcid":false,"given":"H\u00fcseyin","family":"K\u0131lavuz","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Ba\u015fak\u015fehir \u00c7am and Sakura City Hospital, 34480 Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6381-6726","authenticated-orcid":false,"given":"H\u00fcsn\u00fc Ozan","family":"\u015eevik","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Ba\u015fak\u015fehir \u00c7am and Sakura City Hospital, 34480 Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"O\u011fuzhan","family":"Tekin","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Ba\u015fak\u015fehir \u00c7am and Sakura City Hospital, 34480 Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ezgi Do\u011fa","family":"Yoran","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological Surgery, Ba\u015fak\u015fehir \u00c7am and Sakura City Hospital, 34480 Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6292-890X","authenticated-orcid":false,"given":"O\u011fuzhan Hakan","family":"Topg\u00fcl","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological Surgery, Ba\u015fak\u015fehir \u00c7am and Sakura City Hospital, 34480 Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Orkhan","family":"Verdiyev","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological Surgery, Ba\u015fak\u015fehir \u00c7am and Sakura City Hospital, 34480 Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zafer","family":"Teke","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological Surgery, Ba\u015fak\u015fehir \u00c7am and Sakura City Hospital, 34480 Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9069-7774","authenticated-orcid":false,"given":"Sercan","family":"Y\u00fcksel","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Ba\u015fak\u015fehir \u00c7am and Sakura City Hospital, 34480 Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1097\/01.sla.0000133083.54934.ae","article-title":"Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey","volume":"240","author":"Dindo","year":"2004","journal-title":"Ann. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1097\/SLA.0000000000002611","article-title":"Benchmarking complications associated with esophagectomy","volume":"269","author":"Low","year":"2019","journal-title":"Ann. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1097\/SLA.0000000000001098","article-title":"International consensus on standardization of data collection for complications associated with esophagectomy: Esophagectomy Complications Consensus Group (ECCG)","volume":"262","author":"Low","year":"2015","journal-title":"Ann. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1016\/j.hpb.2021.06.414","article-title":"Superiority of CRP-albumin-lymphocyte index (CALLY index) as a non-invasive prognostic biomarker after hepatectomy for hepatocellular carcinoma","volume":"24","author":"Iida","year":"2022","journal-title":"HPB"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1002\/ags3.12637","article-title":"The impact of C-reactive protein-albumin-lymphocyte (CALLY) index on the prognosis of patients with distal cholangiocarcinoma following pancreaticoduodenectomy","volume":"7","author":"Tsunematsu","year":"2023","journal-title":"Ann. Gastroenterol. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"3492","DOI":"10.1016\/j.asjsur.2024.03.054","article-title":"Prognostic usefulness of the C-reactive protein-albumin-lymphocyte (CALLY) index as a novel biomarker in patients undergoing colorectal cancer surgery","volume":"47","author":"Takeda","year":"2024","journal-title":"Asian J. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2749","DOI":"10.1002\/wjs.12357","article-title":"Clinical significance of the CALLY index in patients with gastric cancer undergoing gastrectomy","volume":"48","author":"Sakurai","year":"2024","journal-title":"World J. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"943","DOI":"10.1007\/s00595-024-02813-1","article-title":"Prognostic significance of the preoperative C-reactive protein-albumin-lymphocyte (CALLY) index on outcomes after gastrectomy for gastric cancer","volume":"54","author":"Fukushima","year":"2024","journal-title":"Surg. Today"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Wu, B., Liu, J., Shao, C., Yu, D., and Liao, J. (2025). Integrating inflammation, nutrition, and immunity: The CALLY index as a prognostic tool in digestive system cancers, a systematic review and meta-analysis. BMC Cancer, 25.","DOI":"10.1186\/s12885-025-14074-3"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"102044","DOI":"10.1016\/j.suronc.2024.102044","article-title":"Clinical implications of C-reactive protein-albumin-lymphocyte (CALLY) index in patients with esophageal cancer","volume":"53","author":"Ma","year":"2024","journal-title":"Surg. Oncol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1038\/s41598-023-51109-w","article-title":"Clinical significance of preoperative CALLY index for prognostication in patients with esophageal squamous cell carcinoma undergoing surgery","volume":"14","author":"Feng","year":"2024","journal-title":"Sci. Rep."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"815","DOI":"10.21873\/anticanres.16873","article-title":"CRP-albumin-lymphocyte (CALLY) index is an independent prognostic factor for the esophageal cancer patients who received curative treatment","volume":"44","author":"Aoyama","year":"2024","journal-title":"Anticancer Res."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1007\/s00595-024-02924-9","article-title":"The C-reactive protein-albumin-lymphocyte (CALLY) index is a useful predictor of postoperative complications in patients with a colonic stent for obstructive colorectal cancer: A Japanese multicenter study","volume":"55","author":"Shiraishi","year":"2025","journal-title":"Surg. Today"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"5463","DOI":"10.2147\/JIR.S517074","article-title":"The CALLY index as a predictive tool for postoperative pneumonia in esophageal squamous cell carcinoma: A retrospective cohort study","volume":"18","author":"Xu","year":"2025","journal-title":"J. Inflamm. Res."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Fan, M., Zhu, Y., Qian, L., Hu, C., and Ding, H. (2025). Association between preoperative inflammatory status via CALLY index and postoperative pneumonia occurrence in resectable esophageal squamous cell carcinoma patients: A retrospective cohort study. Front. Oncol., 15.","DOI":"10.3389\/fonc.2025.1486983"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Meng, P., Gu, T., Xu, J., Huang, H., Jin, H., Wang, Y., Zhang, H., and Ruan, Z. (2025). Pretreatment CALLY index as promising novel biomarker in the prediction of surgical and oncological outcomes in esophageal cancer: A multi-center retrospective cohort study. Front. Immunol., 16.","DOI":"10.3389\/fimmu.2025.1605067"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1080","DOI":"10.1136\/bmj.332.7549.1080","article-title":"The cost of dichotomising continuous variables","volume":"332","author":"Altman","year":"2006","journal-title":"BMJ"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1887","DOI":"10.1016\/S0140-6736(12)60516-9","article-title":"Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: A multicentre, open-label, randomised controlled trial","volume":"379","author":"Biere","year":"2012","journal-title":"Lancet"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1097\/SLA.0000000000003031","article-title":"Robot-assisted minimally invasive thoracolaparoscopic esophagectomy versus open transthoracic esophagectomy for resectable esophageal cancer: A randomized controlled trial","volume":"269","author":"May","year":"2019","journal-title":"Ann. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1056\/NEJMoa1805101","article-title":"Hybrid minimally invasive esophagectomy for esophageal cancer","volume":"380","author":"Mariette","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1453","DOI":"10.1016\/S0140-6736(07)61602-X","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies","volume":"370","author":"Altman","year":"2007","journal-title":"Lancet"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2074","DOI":"10.1056\/NEJMoa1112088","article-title":"Preoperative chemoradiotherapy for esophageal or junctional cancer","volume":"366","author":"Hulshof","year":"2012","journal-title":"N. Engl. J. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1948","DOI":"10.1016\/S0140-6736(18)32557-1","article-title":"Perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin, and docetaxel versus fluorouracil or capecitabine plus cisplatin and epirubicin for locally advanced, resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4): A randomised, phase 2\/3 trial","volume":"393","author":"Homann","year":"2019","journal-title":"Lancet"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"837","DOI":"10.2307\/2531595","article-title":"Comparing the areas under two or more correlated receiver operating characteristic curves: A nonparametric approach","volume":"44","author":"DeLong","year":"1988","journal-title":"Biometrics"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1002\/(SICI)1097-0258(19960229)15:4<361::AID-SIM168>3.0.CO;2-4","article-title":"Multivariable prognostic models: Issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors","volume":"15","author":"Harrell","year":"1996","journal-title":"Stat. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1111\/j.2517-6161.1995.tb02031.x","article-title":"Controlling the false discovery rate: A practical and powerful approach to multiple testing","volume":"57","author":"Benjamini","year":"1995","journal-title":"J. R. Stat. Soc. Ser. B"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1373","DOI":"10.1016\/S0895-4356(96)00236-3","article-title":"A simulation study of the number of events per variable in logistic regression analysis","volume":"49","author":"Peduzzi","year":"1996","journal-title":"J. Clin. Epidemiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1995","DOI":"10.1007\/s00268-023-07013-5","article-title":"C-reactive protein as a negative predictive marker for anastomotic leakage after minimally invasive esophageal surgery","volume":"47","author":"Hagens","year":"2023","journal-title":"World J. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1002\/ags3.12294","article-title":"Prognostic significance of systemic inflammatory markers in esophageal cancer: Systematic review and meta-analysis","volume":"4","author":"Ishibashi","year":"2020","journal-title":"Ann. Gastroenterol. Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/19\/7567\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T15:29:42Z","timestamp":1790695782000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/19\/7567"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,29]]},"references-count":29,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2026,10]]}},"alternative-id":["jcm15197567"],"URL":"https:\/\/doi.org\/10.3390\/jcm15197567","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,29]]}}}