Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 14, 2025; 31(30): 109863
Published online Aug 14, 2025. doi: 10.3748/wjg.v31.i30.109863
Association of triglyceride-glucose index with long-term prognosis in advanced hepatocellular carcinoma patients receiving immunotherapy and targeted therapy
Geng-Chen Li, Zhi-Yuan Yao, Hong-Sen Mao, Zheng-Xiang Han
Geng-Chen Li, Zhi-Yuan Yao, Zheng-Xiang Han, Department of Oncology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, Jiangsu Province, China
Hong-Sen Mao, Department of Oncology, People’s Hospital of Jiawang District of Xuzhou City, Xuzhou 221000, Jiangsu Province, China
Co-first authors: Geng-Chen Li and Zhi-Yuan Yao.
Co-corresponding authors: Hong-Sen Mao and Zheng-Xiang Han.
Author contributions: Li GC and Yao ZY were responsible for the methodology of this study, and took part in the data curation of this study; Li GC, Yao ZY, Mao HS, and Han ZX contributed to the conceptualization, writing-review and editing of this manuscript; Li GC contributed to the formal analysis of this manuscript and the visualization of this article; Li GC, Yao ZY, and Mao HS took part in the writing-original draft and investigation of this manuscript; Li GC, Yao ZY, and Han ZX contributed to the project administration and the supervision of this manuscript; Yao ZY and Mao HS were responsible for the validation of this manuscript; Li GC and Han ZX took part in the resources; Mao HS and Han ZX were involved in the supervision of this study. Li GC and Yao ZY contributed equally to this manuscript, they are co-first authors of this manuscript. Han ZX and Mao HS contributed equally to this manuscript, they are co-corresponding authors of this study.
Institutional review board statement: This retrospective study was approved by the Ethics Review Committee of the Affiliated Hospital of Xuzhou Medical University (Approval No. XYFY2022-KL481-01) and adhered to the principles outlined in the Declaration of Helsinki.
Informed consent statement: Given the retrospective design of this investigation, the Ethics Committee of the Affiliated Hospital of Xuzhou Medical University granted us an exemption from obtaining written informed consent.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The datasets used and analysed during the current study available from the corresponding author on reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zheng-Xiang Han, PhD, Professor, Department of Oncology, The Affiliated Hospital of Xuzhou Medical University, No. 99 Huaihai West Road, Xuzhou 221000, Jiangsu Province, China. xzpxlgc@163.com
Received: May 26, 2025
Revised: June 4, 2025
Accepted: July 17, 2025
Published online: August 14, 2025
Processing time: 75 Days and 19.1 Hours
Abstract
BACKGROUND

Primary liver cancer, particularly hepatocellular carcinoma (HCC), ranks as the sixth most prevalent cancer globally and the third major cause of cancer-associated mortality. Despite the available immunotherapies and combined immunotherapy and targeted therapy, the prognosis for many patients remains dismal. Accurately identifying the appropriate patient cohorts is crucial for improving treatment outcomes.

AIM

To investigate the prognostic value of the triglyceride-glucose (TyG) index - a novel, accessible marker of insulin resistance - in predicting therapeutic outcomes among patients with hepatitis B virus (HBV)-related HCC treated with camrelizumab and lenvatinib.

METHODS

In this study, we conducted a retrospective review of 278 patients diagnosed with stage B/C HBV-related HCC who underwent combination therapy. Based on their TyG index, patients were categorized into high and low TyG index groups. A nomogram prediction model was developed based on independent prognostic factors for overall survival (OS) and validated using the C-index and calibration curves.

RESULTS

Of the 278 patients enrolled in the study, 144 were assigned to the high TyG index group, while the remaining 134 were classified into the low index group. Importantly, patients with a low TyG index demonstrated a significantly prolonged median progression-free survival and OS relative to those with a high index. Additionally, the objective response rate and disease control rate were 22.39% and 64.18% in the low TyG index group, whereas they were 12.50% and 51.39% in the high TyG index group, respectively. Moreover, the incidence of hypertension was higher in the high TyG index group than in the low TyG index group. The incidence of other adverse effects did not differ significantly between the groups. Multivariate regression analysis identified independent prognostic factors for OS, including the Barcelona Clinic Liver Cancer stage, alpha-fetoprotein level, Eastern Cooperative Oncology Group score, distant metastasis, and the TyG index. The risk ratio of the TyG index was 0.48 (95% confidence interval: 0.31-0.72, P < 0.001).

CONCLUSION

The TyG index is a reliable long-term predictor of response to combined immunotherapy and targeted therapy in patients with HBV-related HCC. Patients with a low TyG index tend to experience better clinical outcomes.

Keywords: Hepatocellular carcinoma; Triglyceride-glucose index; Camrelizumab; Lenvatinib; Efficacy; Safety

Core Tip: Primary liver cancer ranks among the most prevalent and lethal malignancies worldwide. Although combination therapies have improved treatment options, overall prognosis remains unsatisfactory. The triglyceride-glucose index, a simple surrogate marker of insulin resistance, has recently been associated with tumor progression and immune modulation. This retrospective study evaluates the prognostic significance of the triglyceride-glucose index in patients with advanced hepatocellular carcinoma receiving immunotherapy combined with targeted therapy, offering insights into its potential role in risk stratification and clinical decision-making.