Tarantino Giovanni, Imbimbo Ciro, Ferro Matteo, Bianchi Roberto, La Rocca Roberto, Lucarelli Giuseppe, Lasorsa Francesco, Busetto Gian Maria, Finati Marco, Pastore Antonio Luigi, Al Salhi Yazan, Fuschi Andrea, Terracciano Daniela, Giampaglia Gaetano, Falabella Roberto, Barone Biagio, Fusco Ferdinando, Del Giudice Francesco, Crocetto Felice
Department of Clinical Medicine and Surgery, University of Naples "Federico II", 80131 Naples, Italy.
Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", 80131 Naples, Italy.
J Clin Med. 2025 Apr 11;14(8):2636. doi: 10.3390/jcm14082636.
: Recent evidence has shown that insulin resistance (IR), a hallmark of nonalcoholic fatty liver disease, predicts bladder cancer (BC) presence. However, the best surrogate marker of IR in predicting BC is still unclear. This study examined the relationships among ten surrogate markers of IR and the presence of BC. : Data from 209 patients admitted to two urology departments from September 2021 to October 2024 were retrospectively analyzed. Individuals (median age 70 years) were divided into two groups (123 and 86 patients, respectively) based on the presence/absence after cystoscopy/TURB of non-metastatic BC. Univariate logistic regression was used to determine the relationships between groups, and the following IR parameters: Triglyceride-Glucose (TyG) index, TyG-BMI, HOMA-IR HOMAB, MetS-IR, Single Point Insulin Sensitivity Estimator, Disposition Index, non-HDL/HDL, TG/HDL-C ratio and Lipoprotein Combine Index. Stepwise logistic regressions were carried out to evaluate the significant predictions and LASSO regression to confirm any significant variable(s). The predictive value of the index test for coexistent BC was evaluated using receiver operating characteristic (ROC) curves and the area under the ROC curve (AUC). : The univariate analysis revealed that the TyG index and MetS-IR were associated with the BC presence. Specifically, the associations of the TyG index and MetS-IR were more significant in participants =/> 65 years old. In multivariate analysis, the stepwise logistic regression, evaluating the most representative variables at univariate analysis, revealed a prediction of BC by only TyG index (OR 2.51, = 0.012), confirmed by LASSO regression, with an OR of 3.13, = 0.004). Assessing the diagnostic reliability of TyG, it showed an interesting predictive value for the existence of BC (AUC = 0.60; 95% CI, 0.51-0.68, cut-off 8.50). Additionally, a restricted cubic spline model to fit the dose-response relationship between the values of the index text (TyG) and the BC evidenced the presence of a non-linear association, with a high predictive value of the first knot, corresponding to its 10th percentile. The decision curve analysis confirmed that the model (TyG) has utility in supporting clinical decisions. : Compared to other surrogate markers of IR, the TyG index is effective in identifying individuals at risk for BC. A TyG threshold of 8.5 was highly sensitive for detecting BC subjects and may be suitable as an auxiliary diagnostic criterion for BC in adults, mainly if less than 65 years old.
近期证据表明，胰岛素抵抗（IR）作为非酒精性脂肪性肝病的一个标志，可预测膀胱癌（BC）的存在。然而，IR在预测BC方面的最佳替代标志物仍不明确。本研究探讨了IR的十种替代标志物与BC存在之间的关系。
对2021年9月至2024年10月期间入住两个泌尿外科的209例患者的数据进行回顾性分析。根据膀胱镜检查/TURB后非转移性BC的有无，将个体（中位年龄70岁）分为两组（分别为123例和86例患者）。采用单因素逻辑回归确定两组之间的关系，以及以下IR参数：甘油三酯-葡萄糖（TyG）指数、TyG-BMI、HOMA-IR HOMAB、MetS-IR、单点胰岛素敏感性估计值、处置指数、非HDL/HDL、TG/HDL-C比值和脂蛋白综合指数。进行逐步逻辑回归以评估显著预测因素，并进行LASSO回归以确认任何显著变量。使用受试者工作特征（ROC）曲线和ROC曲线下面积（AUC）评估指数检测对并存BC的预测价值。
单因素分析显示，TyG指数和MetS-IR与BC的存在相关。具体而言，TyG指数和MetS-IR在年龄≥65岁的参与者中相关性更强。在多因素分析中，逐步逻辑回归评估单因素分析中最具代表性的变量，结果显示仅TyG指数可预测BC（OR 2.51，P = 0.012），LASSO回归证实了这一点，OR为3.13，P = 0.004）。评估TyG的诊断可靠性，其对BC的存在显示出有趣的预测价值（AUC = 0.60；95%CI，0.51 - 0.68，截断值8.50）。此外，使用受限立方样条模型拟合指数检测值（TyG）与BC之间的剂量反应关系，证明存在非线性关联，第一个节点具有较高的预测价值，对应于其第10百分位数。决策曲线分析证实该模型（TyG）在支持临床决策方面具有实用性。
与IR的其他替代标志物相比，TyG指数在识别BC风险个体方面有效。TyG阈值为8.5对检测BC受试者具有高度敏感性，可能适合作为成人BC的辅助诊断标准，主要适用于年龄小于65岁的人群。
