Perioperative CALLY dynamics after curative gastrectomy for gastric adenocarcinoma: associations with nodal tumor burden, textbook surgical outcome, and disease-free survival.

BACKGROUND: The C-reactive protein-albumin-lymphocyte index (CALLY) integrates inflammation, nutrition, and cellular immunity. Its relationships with nodal tumor burden and within-patient postoperative recovery after gastrectomy remain unclear. METHODS: This retrospective cohort included 188 patients undergoing R0 gastrectomy for non-metastatic gastric adenocarcinoma. Preoperative CALLY was evaluated in relation to metastatic lymph node count, lymph node ratio (LNR), log odds of positive lymph nodes (LODDS), and pN status. The relationships of perioperative CALLY with major postoperative complications and textbook surgical outcome were evaluated using longitudinal CALLY recovery ratios in 178 patients who underwent open gastrectomy. Primary disease-free survival (DFS) and overall survival (OS) analyses included 165 patients operated on or before 31 May 2025. RESULTS: The median preoperative CALLY was 0.572. Low CALLY was independently associated with high LNR (adjusted odds ratio [aOR], 2.03; 95% CI, 1.04-3.97; p = 0.037) and high LODDS (aOR, 2.11; 95% CI, 1.08-4.14; p = 0.029). Major complications occurred in 40 patients (21.3%), and textbook surgical outcome was achieved in 139 (73.9%). In the open-gastrectomy cohort, CALLY trajectories differed by major complication and textbook surgical outcome status (both interaction p < 0.001). At postoperative day 7 (POD7), recovery ratios were 0.0115 versus 0.0932 in patients with versus without major complications and 0.0156 versus 0.1019 in patients who failed versus achieved textbook surgical outcome (both p < 0.001). During a mean observed follow-up of 27.4 ± 10.6 months, 52 DFS events occurred. Low CALLY was associated with worse DFS (log-rank p = 0.029; univariable hazard ratio, 1.85; 95% CI, 1.06-3.23), whereas the continuous association was attenuated after multivariable adjustment (adjusted hazard ratio, 0.58; 95% CI, 0.33-1.04; p = 0.067). OS did not differ significantly (log-rank p = 0.126). CONCLUSION: Preoperative CALLY was associated with nodal tumor burden, whereas impaired postoperative CALLY recovery reflected adverse postoperative courses. Postoperative CALLY should be interpreted as a monitoring index rather than a predictive biomarker. The DFS association requires external validation.