Assessing the Clinical Relevance of the C-Reactive Protein-Triglyceride-Glucose Index in Cancer Cachexia

Cancer cachexia (CC) is a multifaceted syndrome characterised by declines in appetite, weight, and skeletal muscle which induce fatigue, increased treatment-related toxicity, reduced quality of life, and poor survival rates. CC’s progression involves metabolic disturbances, e.g. alterations in carbohydrate, lipid, and protein metabolism, combined with increased anorexia, insulin resistance (IR), and muscle protein breakdown. The C-reactive protein (CRP)-triglyceride-glucose (TyG) index (CTI), reflecting inflammation and IR levels, is associated with poor cancer prognosis and tumour recurrence. Despite the close association between systemic inflammation, IR, and CC, the CTI remains to be clinically validated in CC patients.

Key learnings:

Prognostic ROC and calibration curves at 1-year, 3-year, and 5-year intervals established the CTI’s robust predictive capability for both short- and long-term survival among CC patients, surpassing the predictive accuracy of CRP or TyG alone. Multivariate survival analyses revealed that an elevated CTI increased the risk of death by 22% across the total cohort for each standard deviation increase in CTI. A significant positive association was also observed between CTI levels and 90-day and 180-day mortality rates in CC patients. Interestingly, subgroup analyses underscored associations between increased CTI levels and treatment modalities such as surgery and radiotherapy. Among patients with advanced-stage cancer cachexia and diabetes, elevated CTI values were linked with poorer survival outcomes. Nevertheless, the CTI’s effects on overall survival in CC patients were found to be mediated by the Patient-Generated Subjective Global Assessment (PGSGA), Eastern Cooperative Oncology Group Performance Status (ECOG PS), and The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-30).

Reviewed by: S. Duarte