Prognostic value of the triglyceride-glucose index in advanced gastric cancer: A call for further exploration

Table 1 The Role of the triglyceride-glucose index in metabolic dysfunction and gastric cancer progression

Metabolic factor	Associated changes	Impact on gastric cancer
Insulin resistance	↑ PI3K/Akt/mTOR activation, ↑ growth signals, ↓ apoptosis	Promotes tumor proliferation and therapy resistance
Lipotoxicity	↑ Free fatty acids, ↑ IL-6/TNF-α, ↑ inflammation	Enhances pro-tumor immune suppression
Glucotoxicity	↑ Oxidative stress, ↑ DNA damage, ↑ chronic inflammation	Facilitates tumor progression and metastasis
Altered TME	↑ Metabolic competition (glucose depletion), ↓ T-cell function	Reduces efficacy of immunotherapy
Hyperlipidemia and obesity	↑ Systemic inflammation, ↑ lipid metabolism dysfunction	Alters immune response, may influence prognosis

PI3K: Phosphatidylinositol 3-kinase; Akt: Protein kinase B; mTOR: Mammalian target of rapamycin; TME: Tumor microenvironment; IL: Interleukin; TNF: Tumor necrosis factor.