Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 7, 2025; 31(5): 102249
Published online Feb 7, 2025. doi: 10.3748/wjg.v31.i5.102249
Impact of triglyceride-glucose index on the long-term prognosis of advanced gastric cancer patients receiving immunotherapy combined with chemotherapy
Zhi-Yuan Yao, Xiao Ma, Yong-Zheng Cui, Jie Liu, Zheng-Xiang Han, Jun Song
Zhi-Yuan Yao, Xiao Ma, Zheng-Xiang Han, Department of Oncology, The Affiliated Hospital of Xuzhou Medical College, Xuzhou 221000, Jiangsu Province, China
Xiao Ma, Department of Oncology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210008, Jiangsu Province, China
Yong-Zheng Cui, Jie Liu, Department of Radiotherapy, The Affiliated Hospital of Xuzhou Medical College, Xuzhou 221000, Jiangsu Province, China
Jun Song, Department of Gastrointestinal Surgery, The Affiliated Hospital of Xuzhou Medical College, Xuzhou 221000, Jiangsu Province, China
Co-first authors: Zhi-Yuan Yao and Xiao Ma.
Co-corresponding authors: Zheng-Xiang Han and Jun Song.
Author contributions: Yao ZY, Ma X, Han ZX, and Song J contributed to the conceptualization, writing-review and editing of this manuscript; Yao ZY and Song J were responsible for the methodology of this study; Yao ZY contributed to the formal analysis of this manuscript and the visualization of this article; Yao ZY, Ma X, and Cui YZ took part in the writing-original draft and investigation of this manuscript; Yao ZY, Han ZX, and Song J contributed to the project administration and the supervision of this manuscript; Ma X, Cui YZ, and Liu J took part in the data curation of this study; Yao ZY and Ma X were responsible for the validation of this manuscript; Liu J took part in the resources; Han ZX and Song J were involved in the supervision of this study; Yao ZY and Ma X contributed equally to the manuscript, they are co-first authors of this manuscript. Han ZX and Song J contributed to this manuscript equally, they are co-corresponding authors of this study.
Institutional review board statement: This research was carried out following the Declaration of Helsinki and received approval from the Ethics Committee at the Affiliated Hospital of Xuzhou Medical University (approval No. XYFY2023-KL277-01).
Informed consent statement: Given the retrospective design of this investigation, the Ethics Committee of the Affiliated Hospital of Xuzhou Medical University granted us an exemption from obtaining written informed consent.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The data included in this study can be obtained from the corresponding author.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jun Song, PhD, Professor, Department of Gastrointestinal Surgery, The Affiliated Hospital of Xuzhou Medical College, No. 99 Huaihai West Road, Quanshan District, Xuzhou 221000, Jiangsu Province, China. 1447795006@qq.com
Received: October 12, 2024
Revised: November 9, 2024
Accepted: December 11, 2024
Published online: February 7, 2025
Processing time: 78 Days and 19.4 Hours
Abstract
BACKGROUND

Gastric cancer (GC) is the fifth most common malignancy and the third leading cause of death worldwide. Despite advancements in immunotherapies, patient prognosis remains poor, necessitating the identification of key prognostic factors to optimize the treatment approaches. Insulin resistance, as indicated by the triglyceride glucose (TyG) index, is increasingly recognized for its impact on cancer progression and immune modulation, and its potential role in GC prognosis is of particular interest.

AIM

To investigate whether the TyG index, a surrogate marker of insulin resistance, can predict the prognosis of patients with advanced GC receiving immunotherapy combined with chemotherapy.

METHODS

This retrospective study included 300 patients with advanced GC who received sintilimab combined with chemotherapy. The patients were categorized into two groups according to high or low TyG index, and independent prognostic factors for overall survival (OS) were determined using Cox proportional hazards regression analysis, which led to the development of a nomogram model.

RESULTS

Of the included patients, 136 had a high TyG index and 164 had a low TyG index. The median progression-free survival of the high TyG index group was significantly longer than that of the low TyG index group. Similarly, the median OS of the high TyG index group was significantly longer than that of the low TyG index group. The objective response and disease control rates in the two groups were 18.38% vs 9.15% and 58.82% vs 46.95%, respectively. No significant difference was noted in the incidence of adverse reactions at any level between the two groups (P > 0.05). In multivariate analysis, the Eastern Cooperative Oncology Group score, programmed cell death ligand 1 expression, and TyG index acted as independent prognostic factors for OS. Of these factors, the hazard ratio of the TyG index was 0.36 (95% confidence interval: 0.36-0.55, P < 0.001), and the nomogram model re-emphasized its importance as the main predictor of patient prognosis, followed by programmed cell death ligand 1 expression and the Eastern Cooperative Oncology Group score.

CONCLUSION

The TyG index is a long-term predictor of the efficacy of immunotherapy combined with chemotherapy, and patients with a high index have a better prognosis.

Keywords: Triglyceride glucose index; Gastric cancer; Sintilimab; Prognostic model; Efficacy; Safety

Core Tip: Gastric cancer (GC) is the fifth most common malignancy. Despite advancements in immunotherapies, patient prognosis remains poor, necessitating the identification of key prognostic factors to optimize treatment approaches. Triglyceride glucose (TyG) index is increasingly recognized for its impact on cancer progression and immune modulation, and its potential role in GC prognosis is of particular interest. However, only a few studies have explored the effect of the TyG index on the prognosis of patients with advanced GC. Therefore, we initiated a retrospective clinical study to explore the impact of the TyG index on the prognosis of patients with advanced GC receiving immunosuppressive agents when combined with chemotherapy.