Real-World Evaluation of the HELPP Score and CALLY Index for Preoperative Prognostic Stratification in Resectable Pancreatic Ductal Adenocarcinoma

Q: What is the main purpose of this study?

To evaluate and compare the prognostic value of the HELPP score and the CALLY index for patients with resectable PDAC before surgery.

Q: How were overall survival and disease-free survival analyzed?

Overall survival and disease-free survival were assessed using Kaplan–Meier analysis, with independent prognostic factors identified through multivariate Cox regression.

Q: Which score showed independent prognostic significance in multivariate analysis?

The HELPP score was identified as an independent predictor of survival in multivariate analysis, while the CALLY index did not reach statistical significance there.

Sep 30, 2026

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Preoperative prognostic assessment is essential for optimizing treatment strategies in pancreatic ductal adenocarcinoma (PDAC). This retrospective study evaluated and compared the Heidelberg Pancreatic Prognostic (HELPP) score and the C-reactive protein–albumin–lymphocyte (CALLY) index in 109 patients with resectable PDAC receiving curative-intent surgery and adjuvant therapy. Outcomes included overall survival and disease-free survival via Kaplan–Meier analysis and independent predictors using multivariate Cox regression. A HELPP score >3 and a low CALLY index (≤1.029) correlated with poorer survival, with HELPP remaining independently significant.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages19

Reading Time48 min

AccessFree to download

Abstract

Background/Objectives

Methods

Results

Conclusions

1. Introduction

Article Real-World Evaluation of the HELPP Score and CALLY Index for Preoperative Prognostic Stratification in Resectable Pancreatic Ductal Adenocarcinoma ˙Ilkay Çıtakkul *, Umut Kefeli , Khatira Shukurova , Zehra Aytin , Yasemin Bakkal Temi , Ece Baydar , Kazım Uygun and Devrim Çabuk Academic Editors: Camelia Cristina Diaconu and Gina Gheorghe Received: 4 December 2025 Revised: 26 December 2025 Accepted: 29 December 2025 Published: 31 December 2025 Copyright: © 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license. Department of Internal Medicine and Medical Oncology, Kocaeli University, 41380 Kocaeli, Turkey; [ukefeli@yahoo.com](ukefeli@yahoo.com) (U.K.); [shukurova.khatira@mail.ru](shukurova.khatira@mail.ru) (K.S.); [dr.zehraonesu@gmail.com](dr.zehraonesu@gmail.com) (Z.A.); [yasemin.temi@kocaeli.edu.tr](yasemin.temi@kocaeli.edu.tr) (Y.B.T.); [ecebaydar@gmail.com](ecebaydar@gmail.com) (E.B.); [kzuygun@hotmail.com](kzuygun@hotmail.com) (K.U.); [devrimcabuk@yahoo.com](devrimcabuk@yahoo.com) (D.Ç.) * Correspondence: [ilkay.citakkul@kocaeli.edu.tr](ilkay.citakkul@kocaeli.edu.tr); Tel.: +90-262-303-7575 Abstract Background/Objectives: Preoperative prognostic assessment is essential for optimizing treatment strategies in pancreatic ductal adenocarcinoma (PDAC) . This study aimed to evaluate and compare the prognostic value of the Heidelberg Pancreatic Prognostic (HELPP) score and the C-reactive protein–albumin–lymphocyte (CALLY) index in patients with resectable PDAC. Methods: We retrospectively analyzed clinical and laboratory data of 109 patients with resectable PDAC who underwent curative-intent surgery and adjuvant therapy. Patients were stratified based on preoperative HELPP and CALLY scores. Overall survival (OS) and disease-free survival (DFS) were assessed using Kaplan–Meier analysis, while independent prognostic factors were determined through multivariate Cox regression. Results: Kaplan–Meier survival analyses demonstrated that a HELPP score > 3 and a low CALLY index (≤1.029) were significantly associated with worse OS and DFS (log-rank p < 0.05) . In multivariate analysis, the HELPP score was identified as an independent predictor of survival, whereas the CALLY index, although associated with survival in univariate analysis, did not reach statistical significance. In ROC analysis, both models exhibited acceptable discrimination, with the HELPP score achieving superior AUC values in predicting 1-year OS compared to the CALLY index. Conclusions: The HELPP score demonstrated independent prognostic value in multivariate analysis and may serve as a robust preoperative tool in resectable PDAC. The CALLY index, although not independently significant in multivariate analysis, showed strong prognostic separation in Kaplan–Meier survival analyses and may still aid in preoperative risk stratification, particularly where access to comprehensive scoring systems is limited. Keywords: pancreatic ductal adenocarcinoma; HELPP score; CALLY index; prognosis; survival 1. Introduction Pancreatic ductal adenocarcinoma (PDAC) continues to be one of the most aggressive malignancies globally, with only marginal improvements in long-term survival despite advancements in surgical and systemic therapies [1,2] . Although surgical resection followed by adjuvant chemotherapy constitutes the cornerstone of treatment for resectable disease, recurrence rates remain high, primarily due to undetected micrometastases and the biologically aggressive nature of the tumor [3,4] . This underscores the urgent need for tools that can guide individualized treatment strategies by accurately stratifying patients preoperatively [5–7] . In recent years, there has been increasing interest in composite inflammatory and nutritional biomarkers as prognostic tools in PDAC [8–15] . Among these, the C-

FAQs

What is the main purpose of this study?

To evaluate and compare the prognostic value of the HELPP score and the CALLY index for patients with resectable PDAC before surgery.

How were overall survival and disease-free survival analyzed?

Overall survival and disease-free survival were assessed using Kaplan–Meier analysis, with independent prognostic factors identified through multivariate Cox regression.

Which score showed independent prognostic significance in multivariate analysis?

The HELPP score was identified as an independent predictor of survival in multivariate analysis, while the CALLY index did not reach statistical significance there.

Sep 30, 2026

Upload by WPS_1790064749