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Systemic inflammation and insulin resistance-related indicator predicts poor outcome in patients with cancer cachexia

Authors :
Guo-Tian Ruan
Li Deng
Hai-Lun Xie
Jin-Yu Shi
Xiao-Yue Liu
Xin Zheng
Yue Chen
Shi-Qi Lin
He-Yang Zhang
Chen-An Liu
Yi-Zhong Ge
Meng-Meng Song
Chun-Lei Hu
Xiao-Wei Zhang
Ming Yang
Wen Hu
Ming-Hua Cong
Li-Chen Zhu
Kun-Hua Wang
Han-Ping Shi
Source :
Cancer & Metabolism, Vol 12, Iss 1, Pp 1-17 (2024)
Publication Year :
2024
Publisher :
BMC, 2024.

Abstract

Abstract Background The C-reactive protein (CRP)-triglyceride-glucose (TyG) index (CTI), which is a measure representing the level of inflammation and insulin resistance (IR), is related to poor cancer prognosis; however, the CTI has not been validated in patients with cancer cachexia. Thus, this study aimed to explore the potential clinical value of the CTI in patients with cancer cachexia. Methods In this study, our prospective multicenter cohort included 1411 patients with cancer cachexia (mean age 59.45 ± 11.38, 63.3% male), which was a combined analysis of multiple cancer types. We randomly selected 30% of the patients for the internal test cohort (mean age 58.90 ± 11.22% 61.4% male). Additionally, we included 307 patients with cancer cachexia in the external validation cohort (mean age 61.16 ± 11, 58.5% male). Receiver operating characteristic (ROC) and calibration curves were performed to investigate the prognostic value of CTI. The prognostic value of the CTI was also investigated performing univariate and multivariate survival analyses. Results The survival curve indicated that the CTI showed a significant prognostic value in the total, internal, and external validation cohorts. Prognostic ROC curves and calibration curves revealed that the CTI showed good consistency in predicting the survival of patients with cancer cachexia. Multivariate survival analysis showed that an elevated CTI increased the risk of death by 22% (total cohort, 95% confidence interval [CI] = 1.13–1.33), 34% (internal test cohort, 95%CI = 1.11–1.62), and 35% (external validation cohort, 95%CI = 1.14–1.59) for each increase in the standard deviation of CTI. High CTI reliably predicted shorter survival (total cohort, hazard ratio [HR] = 1.45, 95%CI = 1.22–1.71; internal test cohort, HR = 1.62, 95%CI = 1.12–2.36; external validation cohort, HR = 1.61, 95%CI = 1.15–2.26). High CTI significantly predicted shorter survival in different tumor subgroups, such as esophageal [HR = 2.11, 95%CI = 1.05–4.21] and colorectal cancer [HR = 2.29, 95%CI = 1.42–3.71]. The mediating effects analysis found that the mediating proportions of PGSGA, ECOG PS, and EORTC QLQ-C30 on the direct effects of CTI were 21.72%, 19.63%, and 11.61%, respectively We found that there was a significant positive correlation between the CTI and 90-day [HR = 2.48, 95%CI = 1.52–4.14] and 180-day mortality [HR = 1.77,95%CI = 1.24–2.55] in patients with cancer cachexia. Conclusion The CTI can predict the short- and long-term survival of patients with cancer cachexia and provide a useful prognostic tool for clinical practice.

Details

Language :
English
ISSN :
20493002
Volume :
12
Issue :
1
Database :
Directory of Open Access Journals
Journal :
Cancer & Metabolism
Publication Type :
Academic Journal
Accession number :
edsdoj.780f5563c06f4918994c8d208aac1aab
Document Type :
article
Full Text :
https://doi.org/10.1186/s40170-024-00332-8