The CALLY recovery ratio: a novel dynamic immunonutritional biomarker for predicting survival after curative gastrectomy in gastric cancer.

BACKGROUND: Systemic inflammation, immune function, and nutritional status are closely linked to survival in gastric cancer (GC). The C-reactive protein-albumin-lymphocyte (CALLY) index integrates these dimensions; however, its dynamic perioperative changes remain unclear. This study evaluated the prognostic significance of the CALLY recovery ratio in patients undergoing curative gastrectomy. METHODS: We retrospectively analyzed 331 patients who underwent radical gastrectomy for gastric adenocarcinoma between January 2016 and December 2019. Preoperative CALLY (pre-CALLY) was calculated using laboratory values obtained within 7 days before surgery, and postoperative CALLY (POD30-CALLY) was assessed on postoperative day 30. The recovery ratio was defined as POD30-CALLY divided by pre-CALLY. Overall survival (OS) was evaluated using Kaplan-Meier analysis and Cox regression. Predictive performance was assessed by 36-month ROC curves. A nomogram incorporating independent prognostic factors was developed and validated. RESULTS: Preoperative inflammatory markers (NLR, PLR, mGPS, and pre-CALLY) were significantly associated with OS, but showed limited discrimination (36-month AUCs 0.573-0.605). POD30-CALLY alone was not significantly predictive (AUC 0.569, P = 0.087). In contrast, the recovery ratio demonstrated superior prognostic performance (AUC 0.704, P < 0.001). Multivariate analysis identified age (HR 1.022), TNM stage (HR 2.051), adjuvant chemotherapy (HR 0.401), and recovery ratio (HR 0.526) as independent predictors of OS. The nomogram showed good calibration and improved clinical net benefit. CONCLUSIONS: The CALLY recovery ratio is an independent and dynamic prognostic biomarker that improves risk stratification after curative gastrectomy.