胰岛素抵抗相关指标与结直肠癌患者预后的关系。

Association between insulin resistance related indicators with the prognosis of patients with colorectal cancer.

机构信息

Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China; National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing 100038, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing 100038, China.

出版信息

Cancer Epidemiol. 2023 Dec;87:102478. doi: 10.1016/j.canep.2023.102478. Epub 2023 Oct 17.

DOI:10.1016/j.canep.2023.102478

PMID:37856934

Abstract

BACKGROUND

The progression of colorectal cancer (CRC) has been linked to metabolism alteration. Because insulin resistance (IR) is the basic mechanism of metabolism alteration, IR related indicators are considered to be associated with prognostic of CRC. In this study, we compared the prognostic values of common IR related indicators for CRC and selected the best one. Moreover, we explored the association between that indicator and CRC prognosis and possible interactive covariates.

METHODS

Medical records of patients with CRC (n = 1765) were retrieved from the Investigation on Nutrition Status and Clinical Outcome of Common Cancers (INSCOC) study. We compared the prognostic values of IR related indicators and select the best one using concordance index (C-index) and area under curve (AUC). Using Cox proportional hazard regression models, we evaluated the association between that indicator and CRC prognosis. Interaction tests were performed to evaluate possible interactions among covariates and the IR related indicator.

RESULTS

Results of C-index and AUC indicated that the ratio of low-density lipoprotein-to-high-density lipoprotein (LHR) showed the highest ability to predict the prognosis of patients with CRC. LHR independently predicted CRC prognosis [hazard ratio (HR) = 1.14; 95 % confidence interval (CI) = 1.05-1.22; P = 0.001]. The interactions between LHR, and age (<65 vs. ≥65; P for interaction = 0.001) or neutrocyte-to-lymphocyte ratio (NLR) (<3 vs. ≥3; P for interaction = 0.055) were also observed.

CONCLUSION

LHR was found to be the best IR related indicators to predict prognosis of CRC, and it was negatively correlated with the prognosis of patients with CRC. NLR and aging might interact with LHR.

摘要

背景

结直肠癌（CRC）的进展与代谢改变有关。由于胰岛素抵抗（IR）是代谢改变的基本机制，因此与 IR 相关的指标被认为与 CRC 的预后相关。在这项研究中，我们比较了常见的 IR 相关指标对 CRC 的预后价值，并选择了最佳指标。此外，我们还探讨了该指标与 CRC 预后的关系以及可能的交互协变量。

方法

从“营养状况与常见癌症临床结局调查（INSCOC）”研究中检索了 CRC 患者（n=1765）的病历。我们使用一致性指数（C-index）和曲线下面积（AUC）比较了 IR 相关指标的预后价值，并选择了最佳指标。使用 Cox 比例风险回归模型，我们评估了该指标与 CRC 预后的关系。进行交互检验以评估协变量和 IR 相关指标之间的可能交互作用。

结果

C-index 和 AUC 的结果表明，低密度脂蛋白与高密度脂蛋白的比值（LHR）预测 CRC 患者预后的能力最高。LHR 独立预测 CRC 预后[风险比（HR）=1.14；95%置信区间（CI）=1.05-1.22；P=0.001]。还观察到 LHR 与年龄（<65 岁与≥65 岁；P 交互=0.001）或中性粒细胞与淋巴细胞比值（NLR）（<3 与≥3；P 交互=0.055）之间的交互作用。