Predictive value of the triglyceride-glucose index for the efficacy of immunotherapy in patients with advanced NSCLC: A retrospective study.

Abstract

e20583 Background: The expression programmed cell death ligand 1(PD-L1) couldn’t exactly predict the efficacy of immune checkpoint inhibitors (ICIs) in patients with non-small-cell lung cancer (NSCLC). Increasing evidence suggests that the triglyceride-glucose index (TyG) is significantly associated with the risk of developing cancers such as NSCLC. Furthermore, research has also shown a potential negative correlation between hyperglycemia and the efficacy of ICIs. This study retrospectively analyzed the relationship between the TyG index and the survival of patients with advanced NSCLC who received ICIs treatment. Methods: Advanced NSCLC patients with ICIs treatment from January 1, 2019 to September 1, 2023 were included. The cutoff value of TyG index for progression-free survival (PFS) stratification was achieved by a receiver operating characteristic curve. Survival was estimated by the Kaplan-Meier method. A p -value of <0.05 indicated statistical significance. Results: Among 235 NSCLC patients who received ICIs treatment at Jinan Central Hospital and The Second Hospital of Shandong University, a total of 95 patients were eligible and subsequently included in this study. At the last follow-up (September 10, 2023), 63 patients (66.32%) were progression disease, 38 patients (40.00%) had died. The cutoff value of TyG index was 8.6 according to ROC curve (The area under the curve =0.632, p= 0.034). Low TyG index cohort showed the characters with age>60 years (32/42, 76.19%), male (35/42, 83.33%), smoking history (29/42, 69.05%), first line immunotherapy (32/42, 76.19%) and combined therapy (32/42, 76.19%). High TyG index cohort showed the similar characters. 5 patients (5/42, 11.90%) in low TyG index cohort had history of diabetes mellitus, and 11 patients (11/53, 20.75%) in high TyG index cohort had history of diabetes mellitus. The medial PFS was 25.0 months (95% CI: 4.8–45.2m) in low TyG index cohort and 9.8 months (95% CI: 6.1–13.5m) in high TyG index cohort (HR=0.46, 95% CI: 0.28–0.76, p =0.003). The medial overall survival was 44.3 months (95% CI: 33.2–55.4m) in low TyG index cohort and 33.7 months (95% CI: 15.9–51.5m) in high TyG index cohort (HR=0.51, 95% CI: 0.26–0.97, p =0.04). Multivariate analysis showed that TyG index was an independent prognostic factor for the OS of NSCLC patients with first line ICIs treatment. Conclusions: Advanced NSCLC patients with low TyG index got better survival benefits from immunotherapy. The TyG index may serve as a useful prognostic indicator for predicting the therapeutic efficacy of ICIs in patients with advanced NSCLC.