Triglyceride-glucose (TyG) index and pancreatic cancer risk: a systematic review and meta-analysis

Abstract

Pancreatic cancer is a deadly malignancy, with a 5-year survival rate of only 13.3% and an annual mortality rate of 11.3 per 100,000. The poor prognosis highlights the need for early screening and risk stratification parameters. Insulin resistance was shown to contribute to pancreatic cancer development and progression. Triglyceride-glucose (TyG) index, a surrogate of insulin resistance, has been increasingly studied in its association with cancer risk. However, its association with pancreatic cancer remains unclear. This study aimed to evaluate the association between TyG index and pancreatic cancer risk through a systematic review and meta-analysis. This review followed a PICO framework: Population – individuals diagnosed with pancreatic cancer; Exposure – TyG index; Comparator – none; Outcomes – incidence of pancreatic cancer and/or overall survival. A systematic search through four databases: PubMed, ProQuest, EBSCOHost, and Google Scholar was conducted. Eligible studies included observational designs assessing TyG index in relation to pancreatic cancer incidence and/or prognosis. Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using random- or fixed-effects models depending on heterogeneity. Four cohort studies met the inclusion criteria, with two eligible for meta-analysis. Two cohort studies evaluated the association between TyG index and pancreatic cancer, while the rest evaluated its association with overall survival in pancreatic cancer. The total number of participants was 938,623 and 1,261, respectively. All studies were of high methodological quality. Pooled analysis demonstrated that each one-standard-deviation increase in TyG index significantly increased pancreatic cancer risk (HR 1.10; 95% CI: 1.06–1.14). Evidence regarding TyG index and survival outcomes in pancreatic cancer patients was limited; however, studies showed that a lower TyG index was associated with better overall survival. TyG index may serve as a simple and accessible risk stratification parameter for pancreatic cancer and has potential prognostic value. Further high-quality studies are required to validate its clinical utility.