Prognostic importance of an indicator related to systemic inflammation and insulin resistance in patients with gastrointestinal cancer: a prospective study

Guo-Tian Ruan; Jin-Yu Shi; Hai-Lun Xie; He-Yang Zhang; Hong Zhao; Xiao-Yue Liu; Yi-Zhong Ge; Xiao-Wei Zhang; Ming Yang; Li-Chen Zhu; Han-Ping Shi

doi:10.3389/fonc.2024.1394892

Prognostic importance of an indicator related to systemic inflammation and insulin resistance in patients with gastrointestinal cancer: a prospective study

Front Oncol. 2024 Dec 2:14:1394892. doi: 10.3389/fonc.2024.1394892. eCollection 2024.

Authors

Guo-Tian Ruan^{1

2

3

4

5}, Jin-Yu Shi^{1

2

3

4

5}, Hai-Lun Xie^{1

2

3

4

5}, He-Yang Zhang^{1

2

3

4

5}, Hong Zhao^{1

2

3

4

5}, Xiao-Yue Liu^{1

2

3

4

5}, Yi-Zhong Ge^{1

2

3

4

5}, Xiao-Wei Zhang^{1

2

3

4

5}, Ming Yang^{1

2

3

4

5}, Li-Chen Zhu^{1

2

3

4

5}, Han-Ping Shi^{1

2

3

4

5}

Affiliations

¹ Department of Gastrointestinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
² Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
³ National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China.
⁴ Key Laboratory of Cancer Foods for Special Medical Purpose (FSMP) for State Market Regulation, Beijing, China.
⁵ Laboratory for Clinical Medicine, Capital Medical University, Beijing, China.

Abstract

Background: Systemic inflammation (SI) and insulin resistance (IR) are correlated to the progression of gastrointestinal (GI) cancer. Therefore, this study aimed to analyze the potential clinical value of the C-reactive protein-triglyceride-glucose index (CTI) in relation to SI and IR in patients with GI cancer.

Methods: This prospective cohort study included patients with GI cancer. Patient data were collected from Fujian Cancer Hospital as an external validation cohort. Prognostic AUC, time-dependent ROC curve, C-index, and calibration curve analyses were used to predict the efficacy and accuracy of CTI survival prediction. Multivariate survival analysis was performed to evaluate the potential prognostic value of the CTI. Multiple logistic regression was performed to evaluate the relationship between the CTI and 90-day and 180-day mortalities.

Results: We divided 1520 patients with GI cancer (mean age, 60.39 ± 11.3 years; male sex, 67%) into a training cohort and internal validation cohort; the external validation cohort included 476 patients. Prognostic AUC, time-dependent ROC curve, C-index, and calibration curve analyses of all cohorts indicated that the CTI could reliably and accurately predict the short- and long-term survival outcomes of patients with GI cancer. Multivariate survival analysis showed that for each standard deviation increase in the CTI, the risk of death increased by 32%, 21%, and 40% in the training, internal validation, and external validation cohorts, respectively. A high CTI was correlated to worse survival in patients with GI cancer (training cohort, hazard ratio [HR]=1.67, 95% confidence interval [CI]=1.35-2.08; internal validation cohort, HR=1.51, 95% CI=1.07-2.14, and external validation cohort, HR=1.59, 95% CI=1.18-2.13). In different tumor subgroups, a high CTI predicted worse survival outcomes for upper GI cancer (HR=1.54, 95% CI=1.18-2.01) and lower GI cancer (HR=1.98, 95% CI=1.36-2.86). Multivariate logistic regression analysis showed that a high CTI was positively correlated with 90-day (odds ratio [OR]=3.25, 95% CI=1.75-6.23) and 180-day mortalities (OR=2.66, 95% CI=1.72-4.15).

Conclusions: The CTI is related to SI and IR and can predict the short- and long-term prognosis of patients with GI cancer. Evaluation of the CTI could provide clinicians with an effective tool for predicting the prognosis of patients with GI cancer.

Clinical trial registration: https://www.chictr.org.cn/showproj.html?proj=31813, identifier ChiCTR1800020329.

Keywords: CTI; gastrointestinal cancer; insulin resistance; overall survival; systemic inflammation.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This work was supported by the National Key Research and Development Program (2022YFC2009600, 2022YFC2009601), Laboratory for Clinical Medicine, Capital Medical University (2023-SYJCLC01), National Multidisciplinary Cooperative Diagnosis and Treatment Capacity Project for Major Diseases: Comprehensive Treatment and Management of Critically Ill Elderly Inpatients (No.2019.YLFW) to H-PS.