Abstract
OBJECTIVE: This study aims to explore the prognostic utility of the CRP-Albumin- Lymphocyte Index (CALLY) in triple-negative breast cancer (TNBC) patients undergoing curative resection. METHODS: A retrospective analysis of 172 TNBC patients treated surgically between January 2011 and December 2020 was conducted. Preoperative CALLY was calculated as (albumin × lymphocyte) / CRP Survival curves for disease free survival (DFS) and overall survival (OS) were estimated using Kaplan-Meier method, and differences between groups were statistically evaluated by Log rank test. Univariate and multivariate Cox proportional hazards regression model were constructed incorporating variables identified as potential independent variables. Nomograms were established according to the multivariate analysis results, and with internal validation performed using the consistency index (C-index), calibration curve, and decision curve analyses (DCA). RESULTS: Patients were stratified into low CALLY group (<0.44, n=83) and high CALLY group (≥0.44, n=89) based on the optimal cutoff value of CALLY determined by receiver operating characteristic curve (ROC) analysis. High CALLY correlated with significantly prolonged DFS (32.54 vs. 28.97 months; χ(2)=14.070, P=0.0002) and OS (59.87 vs. 45.20 months; χ(2)=17.800, P<0.0001). Multivariate regression analysis revealed that CALLY as an independent predictor of DFS (hazard ratio [HR]: 0.275, 95% confidence interval [CI]: 0.140-0.539, P<0.001) and OS (HR: 0.372, 95% CI: 0.182-0.764, P = 0.007). Nomograms integrating CALLY, TOP2A, and postoperative chemotherapy demonstrated robust predictive accuracy for DFS (C-index: 0.717, 95% CI 0.595-0.814) and OS (C-index: 0.725, 95% CI 0.605-0.819). CONCLUSION: CALLY reflects systemic inflammation, nutrition, and immune status, and represents a novel prognostic index for TNBC. Its integration into nomograms enhances personalized risk stratification and treatment decision-making.