Hao QL, Yao ZY, Shen YM, Li ZY, Gao HC, Hong XY, Li GC, Gao C. Prognostic significance of preoperative C-reactive protein-triglyceride-glucose index in long-term outcomes after radical gastrectomy for gastric cancer. World J Gastrointest Oncol 2025; 17(12): 113976 [DOI: 10.4251/wjgo.v17.i12.113976]
Corresponding Author of This Article
Chao Gao, MD, Professor, Department of Oncology, The Affiliated Hospital of Xuzhou Medical University, No. 99 Huaihai West Road, Xuzhou 221000, Jiangsu Province, China. gaochaoly@sina.com
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Oncology
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Retrospective Study
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Dec 15, 2025 (publication date) through Dec 17, 2025
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World Journal of Gastrointestinal Oncology
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1948-5204
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Hao QL, Yao ZY, Shen YM, Li ZY, Gao HC, Hong XY, Li GC, Gao C. Prognostic significance of preoperative C-reactive protein-triglyceride-glucose index in long-term outcomes after radical gastrectomy for gastric cancer. World J Gastrointest Oncol 2025; 17(12): 113976 [DOI: 10.4251/wjgo.v17.i12.113976]
World J Gastrointest Oncol. Dec 15, 2025; 17(12): 113976 Published online Dec 15, 2025. doi: 10.4251/wjgo.v17.i12.113976
Prognostic significance of preoperative C-reactive protein-triglyceride-glucose index in long-term outcomes after radical gastrectomy for gastric cancer
Qiu-Lin Hao, Zhi-Yuan Yao, Yu-Meng Shen, Zheng-Yu Li, Hao-Chun Gao, Xiao-Yu Hong, Geng-Chen Li, Chao Gao, Department of Oncology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, Jiangsu Province, China
Co-first authors: Qiu-Lin Hao and Zhi-Yuan Yao.
Author contributions: Gao C, Hao QL, and Yao ZY designed the research; Gao HC, Hong XY, and Li GC have made contributions to data collection and organization; Shen YM and Li ZY conducted statistical analysis; Hao QL and Yao ZY made equal contributions to writing the original draft, and they are co first authors; all authors have read and approved the final manuscript.
Institutional review board statement: This research was carried out following the Declaration of Helsinki and received approval from the Ethics Committee at the Affiliated Hospital of Xuzhou Medical University (No. XYFY2023-KL277-01).
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: The authors declare that they have no conflict of interest.
Data sharing statement: The data included in this study can be obtained from the corresponding author at gaochaoly@sina.com.
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: Chao Gao, MD, Professor, Department of Oncology, The Affiliated Hospital of Xuzhou Medical University, No. 99 Huaihai West Road, Xuzhou 221000, Jiangsu Province, China. gaochaoly@sina.com
Received: September 9, 2025 Revised: September 26, 2025 Accepted: November 6, 2025 Published online: December 15, 2025 Processing time: 94 Days and 5.4 Hours
Abstract
BACKGROUND
Gastric cancer, a globally prevalent malignant tumor, continues to exhibit high incidence and mortality rates. Although radical gastrectomy remains the primary treatment for this disease, postoperative complications frequently arise, negatively impacting short-term recovery and significantly reducing patients’ quality of life. In this context, accurately predicting the risk of postoperative recurrence and metastasis, coupled with targeted interventions, could substantially improve patient outcomes. The C-reactive protein-triglyceride-glucose index (CTI), a composite biomarker that integrates metabolic disturbances and systemic inflammation, has garnered increasing attention in oncology. The prognostic nutritional index (PNI), a composite measure based on serum albumin and peripheral blood lymphocyte count, is used to evaluate both the nutritional status and systemic immune function of patients. In recent years, both the CTI and PNI have demonstrated significant prognostic value in predicting tumor outcomes, assessing treatment responses, and formulating personalized treatment strategies.
AIM
To investigate whether the combined inflammation and insulin resistance marker, the CTI, can serve as a prognostic indicator for patients undergoing radical gastrectomy for gastric cancer. Additionally, it seeks to develop a predictive model by incorporating the PNI alongside CTI.
METHODS
This retrospective study included a total of 300 patients who underwent radical gastrectomy. The patients were classified into high and low CTI groups based on their CTI index. Cox proportional hazards regression analysis was performed to identify independent prognostic factors influencing overall survival (OS) and disease-free survival (DFS), and two nomogram models were developed.
RESULTS
Of the included patients, 131 had a high CTI and 169 had a low CTI. The DFS period of the low CTI group was significantly longer than that of the high CTI group. The number of postoperative adjuvant treatments, T stage, N stage, CTI, and PNI were identified as independent prognostic factors for DFS. The hazard ratio for CTI was 2.07 (95% confidence interval: 1.36-3.17, P < 0.001). In terms of OS, the OS period of the low CTI group was significantly longer than that of the high CTI group. Whether adjuvant treatment was administered, T stage, CTI, and PNI were independent prognostic factors for OS. The hazard ratio for CTI was 2.47 (95% confidence interval: 1.44-4.23, P = 0.001). The nomogram models for OS and DFS further emphasized the importance of CTI as a key predictor of patient prognosis.
CONCLUSION
CTI is a long-term prognostic indicator for the outcome of radical gastrectomy for gastric cancer. Patients with lower CTI values have a better prognosis. The prediction models constructed by combining CTI with PNI has good predictive ability for DFS and OS after radical gastrectomy.
Core Tip: Gastric cancer is the third leading cause of cancer-related mortality worldwide. Radical surgery remains the primary treatment for early-stage gastric cancer, but the overall survival rate post-surgery remains relatively low. Identifying key prognostic factors is essential to optimize treatment strategies. The C-reactive protein-triglyceride-glucose (CTI) index, which integrates both inflammatory and metabolic markers, has garnered increasing attention in cancer research, particularly in gastric cancer prognosis. However, few studies have explored the impact of CTI on cancer patient outcomes. Therefore, we conducted a retrospective clinical study to examine the influence of CTI on the prognosis of patients undergoing radical gastrectomy for gastric cancer and developed a corresponding predictive model. Additionally, we incorporated the prognostic nutritional index coefficient to improve the predictive accuracy of the model.
