Immunonutritive Scoring for Patients with Hepatocellular Carcinoma Undergoing Transarterial Chemoembolization: Evaluation of the CALLY Index

SIMPLE SUMMARY: The novel CRP–albumin–lymphocyte (CALLY) index has been identified as a highly predictive tool for stratification of patients with hepatocellular carcinoma (HCC) who have undergone tumor resection. This study aimed to validate the predictive ability of the CALLY index in patients with HCC treated with transarterial chemoembolization (TACE). The CALLY index was an independent prognostic predictor for overall survival. However, the CALLY index was not superior to other immunonutritive and inflammation scoring systems in predicting the median OS, although all of the individual parameters of the CALLY index were predictive for the median OS. Thus, future studies should re-evaluate the mathematical calculation of the index for patients with HCC undergoing TACE. ABSTRACT: The novel CRP–albumin–lymphocyte (CALLY) index is an improved immunonutritive scoring system, based on serum C-reactive protein (CRP), serum albumin, and the lymphocyte count. It has shown promise as a prognostic index for patients with hepatocellular carcinoma (HCC) undergoing resections. This study evaluated the prognostic ability of the CALLY index for patients with HCC undergoing transarterial chemoembolization (TACE). We retrospectively identified 280 treatment-naïve patients with HCC that underwent an initial TACE at our institution, between 2010 and 2020. We compared the CALLY index to established risk factors in univariate and multivariate regression analyses for associations with median overall survival (OS). A low CALLY score was associated with low median OS (low vs. high CALLY: 9.0 vs. 24.0 months, p < 0.001). In the multivariate analysis, the CALLY index remained an independent prognostic predictor (p = 0.008). Furthermore, all factors of the CALLY index reached significance in univariate and in-depth multivariate analyses. However, the concordance index (C-index) of the CALLY index (0.60) was similar to the C-indices of established immunonutritive and inflammation scoring systems (range: 0.54 to 0.63). In conclusion, the CALLY index showed promise as a stratification tool for patients with HCC undergoing TACE. Notably, the CALLY index was not superior to other immunonutritive and inflammation scoring systems in predicting the median OS. Thus, future studies should re-evaluate the mathematical calculation of the index, particularly the contributions of individual parameters.