Utility of novel composite index in predicting the prognosis of total neoadjuvant therapy for locally advanced rectal cancer: A multicenter real-world cohort study.

Objective: C-reactive protein-albumin-lymphocyte (CALLY) is a novel composite index. Total neoadjuvant therapy (TNT) has become one of the standard treatments for locally advanced rectal cancer (LARC). It remains unclear whether CALLY can predict the prognosis for LARC patients.

Methods: Restricted cubic spline (RCS) was employed to assess the relationships of CALLY with perioperative complications, pathologic complete response (pCR), disease-free survival (DFS) and overall survival (OS).

Results: This multicenter, real-world study included 995 LARC patients treated with TNT. RCS analysis demonstrated a linear association between CALLY and TNT-related adverse events, postoperative complications, DFS, and OS (all P for nonlinear > 0.05, P overall < 0.05). The high CALLY group (≥13.5) had significantly better DFS and OS than the low CALLY (P < 0.001). The 3- and 5-year DFS of low CALLY patients were 63.0 % and 51.6 %, and the 3- and 5-year OS were 75.6 % and 59.7 %, respectively. In the high CALLY group, the 3- and 5-year DFS were 87.0 % and 77.6 %, and the 3- and 5-year OS were 90.1 % and 81.8 %.

Conclusion: Baseline CALLY can serve as an effective prognostic tool for LARC patients undergoing TNT and guide personalized treatment strategies.