Impact of triglyceride-glucose index on the long-term prognosis of advanced gastric cancer patients receiving immunotherapy combined with chemotherapy

doi:10.3748/wjg.v31.i5.102249

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Gastroenterol. Feb 7, 2025; 31(5): 102249
Published online Feb 7, 2025. doi: 10.3748/wjg.v31.i5.102249

Table 1 Baseline characteristics of triglyceride glucose index < 1.79 and triglyceride glucose index ≥ 1.79, n (%)

Variables	Overall (n = 300)	Low TyG index (n = 164)	High TyG index (n = 136)	P value
BMI, kg/m², mean ± SD	22.71 ± 2.93	22.12 ± 2.86	23.42 ± 2.86	< 0.001^a
Fasting glucose, mg/dL, mean ± SD	6.53 ± 1.77	5.20 ± 1.02	8.13 ± 0.99	< 0.001^a
Fasting triglycerides, mg/dL, mean ± SD	1.74 ± 0.41	1.45 ± 0.27	2.09 ± 0.23	< 0.001^a
Tyg index, mean ± SD	1.67 ± 0.54	1.29 ± 0.43	2.12 ± 0.22	< 0.001^a
Age, years				0.514
< 60	135 (45.00)	71 (43.29)	64 (47.06)
≥ 60	165 (55.00)	93 (56.71)	72 (52.94)
Sex				0.833
Female	152 (50.67)	84 (51.22)	68 (50.00)
Male	148 (49.33)	80 (48.78)	68 (50.00)
Drinking history				0.387
No	204 (68.00)	115 (64.02)	89 (65.44)
Yes	92 (32.00)	49 (29.88)	47 (34.56)
Smoking history				0.859
No	208 (69.33)	113 (68.90)	95 (69.85)
Yes	92 (30.67)	51 (31.10)	41 (30.15)
ECOG				0.583
0	198 (66.00)	106 (64.63)	92 (67.65)
1	102 (34.00)	58 (35.37)	44 (32.35)
Site				0.054
Stomach	150 (50.17)	74 (45.12)	64 (47.06)
Gastric and esophageal binding	149 (49.83)	90 (54.88)	72 (52.94)
Histological				0.189
Adenocarcinoma	216 (72.00)	113 (68.90)	103 (75.74)
Other	84 (28.00)	51 (31.10)	33 (24.26)
CEA, ng/mL				0.188
< 3	90 (30.00)	44 (26.81)	46 (33.82)
≥ 3	210 (72.00)	120 (73.17)	90 (66.18)
AFP, ng/mL				0.169
< 15	253 (84.33)	134 (81.71)	119 (87.50)
≥ 15	47 (15.67)	30 (18.29)	17 (12.50)
CA-199, ng/mL				0.071
< 37	184 (61.33)	93 (56.71)	91 (66.91)
≥ 37	116 (38.67)	71 (43.29)	45 (33.09)
Liver metastasis				0.798
No	194 (64.67)	105 (70.12)	89 (65.44)
Yes	106 (35.33)	59 (35.98)	47 (34.56)
Peritoneal metastasis				0.423
No	241 (80.33)	129 (78.66)	112 (82.35)
Yes	59 (19.67)	35 (21.34)	24 (17.65)
EBV status				0.390
No-infect	253 (84.33)	141 (85.98)	112 (82.35)
Infect	47 (15.67)	23 (14.02)	24 (17.65)
PD-L1 expression				0.059
CPS < 5	51 (17.00)	34 (20.73)	17 (12.50)
CPS ≥ 5	249 (83.00)	130 (79.27)	119 (87.50)
MMR status				0.125
pMMR	289 (96.33)	155 (94.51)	134 (98.53)
dMMR	11 (3.67)	9 (5.49)	2 (1.47)

^aP < 0.05.

TyG: Triglyceride glucose; BMI: Body mass index; ECOG: Eastern Cooperative Oncology Group; CEA: Carcinoembryonic-antigen; AFP: Alpha-fetoprotein: CA-199: Carbohydrate antigen 199; EBV: Epstein-Barr virus; PD-L1: Programmed cell death ligand 1; CPS: Combined positive score; MMR: Mismatch repair; pMMR: Proficient mismatch repair; dMMR: Deficient mismatch repair.

Table 2 Tumor responses of triglyceride glucose index < 1.79 and triglyceride glucose index ≥ 1.79, n (%)

Variables	Low TyG index (n = 164)	High TyG index (n = 136)	χ²	P value
CR
0	164 (100.00)	135 (99.26)
1	0 (0.00)	1 (0.74)
PR
0	149 (90.85)	112 (82.35)
1	15 (9.15)	24 (17.65)
SD
0	102 (62.20)	81 (59.56)
1	62 (37.80)	55 (40.44)
PD
0	77 (46.95)	80 (58.82)
1	87 (53.05)	56 (41.18)
ORR			5.49	0.020^a
0	149 (90.85)	111 (81.62)
1	15 (9.15)	25 (18.38)
DCR			4.20	0.040^a
0	87 (53.05)	56 (41.18)
1	77 (46.95)	80 (58.82)

^aP < 0.05.

TyG: Triglyceride glucose; CR: Complete response; PR: Partial response; SD: Stable disease; PD: Progression disease; ORR: Objective responds rates; DCR: Disease control rates.

Table 3 Univariate and multivariate analyses of prognostic factors for progression-free survival

Factors	Univariate		Multivariate
Factors	HR (95%CI)	P value	HR (95%CI)	P value
Age (≥ 60 vs < 60), years	0.83 (0.62-1.12)	0.222
Sex (male vs female)	1.01 (0.75-1.35)	0.954
Drinking history (yes vs no)	0.97 (0.71-1.33)	0.866
Smoking history (yes vs no)	0.96 (0.70-1.33)	0.818
Site (stomach vs gastric and esophageal binding)	1.14 (0.85-1.53)	0.388
ECOG (0 vs 1)	1.86 (1.36-2.54)	< 0.001^a	1.58 (1.14-2.20)	0.006^a
Histological (others vs adenocarcinoma)	0.94 (0.68-1.31)	0.732
TyG (low vs high)	0.58 (0.43-0.79)	< 0.001^a	0.66 (0.48-0.90)	0.010^a
CEA (< 3 vs ≥ 3), ng/mL	1.27 (0.91-1.76)	0.159
AFP (≥ 15 vs < 15), ng/mL	0.79 (0.50-1.23)	0.298
CA-199 (< 37 vs ≥ 37), ng/mL	1.22 (0.91-1.64)	0.188
Liver metastasis (yes vs no)	0.89 (0.65-1.21)	0.459
Peritoneal metastasis (no vs yes)	1.02 (0.71-1.49)	0.899
EBV status (infect vs no-infect)	0.82 (0.55-1.23)	0.341
PD-L1 expression (CPS < 5 vs CPS ≥ 5)	0.27 (0.18-0.40)	< 0.001^a	0.37 (0.25-0.56)	< 0.001^a
MMR status (pMMR vs dMMR)	2.61 (0.97-7.03)	0.058
BMI (< 25 vs ≥ 25), kg/m²	0.55 (0.37-0.82)	0.003^a	0.56 (0.38-0.84)	0.005^a

^aP < 0.05.

HR: Hazard ratio; CI: Confidence interval; ECOG: Eastern Cooperative Oncology Group; TyG: Triglyceride glucose; CEA: Carcinoembryonic-antigen; AFP: Alpha-fetoprotein: CA-199: Carbohydrate antigen 199; EBV: Epstein-Barr virus; PD-L1: Programmed cell death ligand 1; CPS: Combined positive score; MMR: Mismatch repair; pMMR: Proficient mismatch repair; dMMR: Deficient mismatch repair; BMI: Body mass index.

Table 4 Univariate and multivariate analyses of prognostic factors for overall survival

Factors	Univariate		Multivariate
Factors	HR (95%CI)	P value	HR (95%CI)	P value
Age (≥ 60 vs < 60), years	0.86 (0.59-1.24)	0.410
Sex (male vs female)	1.16 (0.80-1.67)	0.434
Drinking history (no vs yes)	1.14 (0.78-1.67)	0.503
Smoking history (no vs yes)	1.12 (0.76-1.64)	0.567
Site (stomach vs gastric and esophageal binding)	1.10 (0.76-1.60)	0.613
ECOG (0 vs 1)	1.90 (1.27-2.86)	0.002^a	1.68 (1.10-2.59)	0.017^a
Histological (others vs adenocarcinoma)	0.86 (0.58-1.28)	0.466
TyG (low vs high)	0.33 (0.22-0.50)	< 0.001^a	0.36 (0.24-0.55)	< 0.001^a
CEA (< 3 vs ≥ 3), ng/mL	1.11 (0.73-1.69)	0.635
AFP (< 15 vs ≥ 15), ng/mL	1.15 (0.69-1.93)	0.593
CA-199 (< 37 vs ≥ 37), ng/mL	1.23 (0.85-1.79)	0.267
Liver metastasis (no vs yes)	1.20 (0.83-1.74)	0.335
Peritoneal metastasis (no vs yes)	1.27 (0.81-1.98)	0.294
EBV status (infect vs no-infect)	0.77 (0.45-1.33)	0.355
PD-L1 expression (CPS < 5 vs CPS ≥ 5)	0.31 (0.19-0.51)	< 0.001^a	0.49 (0.29-0.82)	0.007^a
MMR status (pMMR vs dMMR)	1.21 (0.45-3.30)	0.707
BMI (< 25 vs ≥ 25), kg/m²	0.72 (0.45-1.14)	0.159

^aP < 0.05.

Table 5 Comparison of features between the training and validation sets, n (%)

Characteristic	Test (n = 90)	Train (n = 210)	χ²	P value
Age, years			1.94	0.164
< 60	46 (51.11)	89 (42.38)
≥ 60	44 (48.89)	121 (57.62)
Sex			0.43	0.512
Female	43 (47.78)	109 (51.90)
Male	47 (52.22)	101 (48.10)
BMI, kg/m²			0.21	0.646
< 25	69 (76.67)	166 (79.05)
≥ 25	21 (23.33)	44 (20.95)
TyG			0.31	0.578
Low	47 (52.22)	117 (55.71)
High	43 (47.78)	93 (44.29)
Drinking history			0.24	0.627
No	63 (70.00)	141 (67.14)
Yes	27 (30.00)	69 (32.86)
Smoking history			1.58	0.209
No	67 (74.44)	141 (67.14)
Yes	23 (25.56)	69 (32.86)
ECOG			0.41	0.523
0	57 (63.33)	141 (67.14)
1	33 (36.67)	69 (32.86)
Site			0.08	0.772
Stomach	44 (48.89)	106 (50.72)
Gastric and esophageal binding	46 (51.11)	103 (49.28)
Histological			1.39	0.239
Adenocarcinoma	21 (23.33)	63 (30.00)
Other	69 (76.67)	147 (70.00)
CEA, ng/mL			3.70	0.054
< 3	34 (37.78)	56 (26.67)
≥ 3	56 (62.22)	154 (73.33)
AFP, ng/mL			1.83	0.176
< 15	72 (80.00)	181 (86.19)
≥ 15	18 (20.00)	29 (13.81)
CA-199, ng/mL			1.54	0.214
< 37	60 (66.67)	124 (59.05)
≥ 37	30 (33.33)	86 (40.95)
Liver metastasis			1.60	0.206
No	63 (70.00)	131 (62.38)
Yes	27 (30.00)	79 (37.62)
Peritoneal metastasis			0.73	0.392
No	75 (83.33)	166 (62.38)
Yes	15 (16.67)	79 (37.62)
EBV status			0.10	0.578
No-infect	75 (83.33)	178 (84.76)
Infect	15 (16.67)	32 (15.24)
PD-L1 expression			0.60	0.440
CPS < 5	13 (14.44)	38 (18.10)
CPS ≥ 5	77 (85.56)	172 (81.90)
MMR status			0.02	0.893
pMMR	4 (4.44)	7 (3.33)
dMMR	86 (95.56)	203 (96.67)

BMI: Body mass index; TyG: Triglyceride glucose; ECOG: Eastern Cooperative Oncology Group; CEA: Carcinoembryonic-antigen; AFP: Alpha-fetoprotein: CA-199: Carbohydrate antigen 199; EBV: Epstein-Barr virus; PD-L1: Programmed cell death ligand 1; CPS: Combined positive score; MMR: Mismatch repair; pMMR: Proficient mismatch repair; dMMR: Deficient mismatch repair.

Table 6 Adverse events associated with sintilimab plus chemotherapy in gastric cancer patients, n (%)

Variables	Low TyG index (n = 164)	High TyG index (n = 136)	χ²	P value
All grades: Leukopenia	71 (43.29)	62 (45.59)	0.26	0.607
All grades: Anemia	68 (41.46)	58 (42.65)	0.00	0.989
All grades: Neutropenia	63 (38.41)	50 (36.75)	0.09	0.769
All grades: Thrombocytopenia	58 (35.37)	47 (34.56)	0.00	0.959
All grades: Nausea	50 (30.49)	38 (27.94)	0.23	0.630
All grades: Pyrexia	40 (24.39)	36 (26.47)	0.17	0.680
All grades: Elevated ALT	34 (20.73)	24 (17.65)	0.45	0.501
All grades: Elevated AST	34 (20.73)	22 (16.18)	1.02	0.313
All grades: Hypothyroidism	32 (19.51)	31 (22.79)	0.48	0.487
All grades: Diarrhea	29 (17.68)	32 (23.52)	1.57	0.210
All grades: Hypertension	24 (14.63)	19 (13.97)	0.03	0.870
All grades: Pneumonitis	20 (12.20)	17 (12.50)	0.02	0.898
All grades: Proteinuria	18 (10.98)	12 (8.82)	0.38	0.536
All grades: Hyperbilirubinemia	17 (10.37)	12 (8.82)	0.20	0.653
All grades: Fatigue	16 (9.80)	13 (10.29)	0.00	0.954
≥ 3 grades: Thrombocytopenia	30 (18.29)	22 (16.18)	0.23	0.630
≥ 3 grades: Neutropenia	21 (12.80)	14 (10.29)	0.45	0.500
≥ 3 grades: Leukopenia	19 (11.59)	15 (11.03)	0.02	0.880
≥ 3 grades: Anemia	15 (9.15)	10 (7.35)	0.31	0.576
≥ 3 grades: Diarrhea	8 (4.88)	6 (4.41)	0.04	0.849
≥ 3 grades: Nausea	7 (4.27)	5 (3.68)	0.07	0.795
≥ 3 grades: Elevated ALT	5 (3.05)	4 (2.94)	0.08	0.775
≥ 3 grades: Elevated AST	4 (5.88)	2 (1.47)	0.03	0.855
≥ 3 grades: Hypothyroidism	3 (1.83)	4 (2.94)	0.04	0.833
≥ 3 grades: Hypertension	3 (1.83)	2 (1.47)	0.05	0.819
≥ 3 grades: Pneumonitis	3 (1.83)	2 (1.47)	0.05	0.819
≥ 3 grades: Hyperbilirubinemia	2 (1.22)	2 (1.47)	0.09	0.763
≥ 3 grades: Fatigue	0 (0.00)	0 (0.00)	-	-
≥ 3 grades: Pyrexia	0 (0.00)	0 (0.00)	-	-
≥ 3 grades: Proteinuria	0 (0.00)	0 (0.00)	-	-

TyG: Triglyceride glucose; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase.

Citation: Yao ZY, Ma X, Cui YZ, Liu J, Han ZX, Song J. Impact of triglyceride-glucose index on the long-term prognosis of advanced gastric cancer patients receiving immunotherapy combined with chemotherapy. World J Gastroenterol 2025; 31(5): 102249
URL: https://www.wjgnet.com/1007-9327/full/v31/i5/102249.htm
DOI: https://dx.doi.org/10.3748/wjg.v31.i5.102249