A Novel Inflammation and Insulin Resistance Related Indicator to Predict the Survival of Patients With Cancer

Abstract

Background: Systemic inflammation and insulin resistance (IR) are closely related in patients with cancer. However, there is no relevant indicator that combines inflammation and IR to predict patient prognosis. Therefore, this study aimed to develop and validate a novel inflammation- and IR-related marker in patients with cancer.

Methods: The total cohort of this study included 5221 patients with cancer, and the training and validation cohorts were randomized in a 7:3 ratio. C-reactive protein (CRP) and fasting triglyceride glucose (TyG) were used to reflect patients' inflammation and IR status, respectively. The CRP-TyG index (CTI) was composed of CRP and TyG. The concordance (C)-index, receiver operator characteristic (ROC) curve, and calibration curve reflected the prognostic predictive power of CTI. Univariate and multivariate survival analyses predicted the prognostic value of CTI in patients with cancer.

Results: The C-indices of CTI in patients with cancer were 0.636, 0.617, and 0.631 in the total, training, and validation cohorts, respectively. The 1-, 3-, and 5-year ROC and calibration curves showed that CTI had a good predictive ability of survival in patients with cancer. Meanwhile, patients with high CTI had a worse prognosis compared to patients with low CTI (total cohort: hazard ratio [HR] = 1.46, 95% confidence interval [95% CI] = 1.33-1.59; training cohort: HR = 1.36, 95% CI = 1.22-1.52; validation cohort: HR = 1.73, 95% CI = 1.47-2.04].

Conclusion: The CTI is a useful prognostic indicator of poor prognosis and a promising tool for treatment strategy decision-making in patients with cancer.

Keywords: CRP; TyG; insulin resistance; overall survival; systemic inflammation.

Figure 1

The distribution of CTI in different groups. (A) CTI in TNM stage groups; (B) CTI in TNM stage groups stratified by age; (C) CTI in TNM stage groups stratified by sex; (D) CTI in BMI groups; (E) CTI in BMI groups stratified by age; (F) CTI in BMI groups stratified by sex. CTI, C-reactive protein-triglyceride glucose index; BMI, body mass index. *, P<0.05; **, P<0.01; ****,P<0.0001; ns, not significant.

Figure 2

The 1-, 3-, and 5-year prognostic ROC curves of CTI in the different cohorts of patients with cancer. (A) 1- year prognostic ROC curve; (B) 3- year prognostic ROC curve; (C) 5- year prognostic ROC curve. Green line, total cohort; Blue line, training cohort; Red line, validation cohort. CTI, C-reactive protein-triglyceride glucose index; ROC, receiver operating characteristic.

Figure 3

The 1-, 3-, and 5-year calibration curves of CTI in the different cohorts of patients with cancer. (A–C) 1-, 3-, and 5-year calibration curves of CTI in total cohort. (D–F) 1-, 3-, and 5-year calibration curves of CTI in training cohort. (G–) 1-, 3-, and 5-year calibration curves of CTI in validation cohort. CTI, C-reactive protein-triglyceride glucose index.

Figure 4

The Kaplan-Meier survival curves of CTI in the different cohorts of patients with cancer. (A) Total cohort; (B) Training cohort; (C) Validation cohort; (D–M) Different tumor types based on total cohort: (D)Lung cancer; (E) Esophageal cancer; (F) Gastric cancer; (G) Colorectal cancer; (H) Other digsestive cancer; (I) Breast cancer; (J) Female reproductive cancer; (K) Urological cancer; (L) Nasopharyngeal cancer; (M) Other cancer; CTI, C-reactive protein-triglyceride glucose index.

Figure 5

The subgroup analysis of the CTI in the total cohort of patients with cancer. Adjusted for age, sex, TNM stage, BMI, tumor types, KPS, surgery, chemotherapy, radiotherapy, smoking, alcohol, nutritional intervention, hypertension, coronary heart disease, diabetes, and TSF. CTI, C-reactive protein-triglyceride glucose index; BMI, body mass index; KPS, karnofsky performance status; TSF, triceps skin fold.