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June 14, 2026International Journal of Surgery0 citationsOpen Access

Association between triglyceride-glucose-related indices and mortality in cancer survivors: a cross-sectional cohort study

BXBinbin XuFujian Medical University QZQuxia ZhangFujian Medical University

Key Points

This research investigates the association between triglyceride-glucose-related indices and mortality among cancer survivors.
Analyzed data from 1737 adult cancer survivors (1999-2018 NHANES)
Utilized weighted Cox models and restricted cubic splines to assess mortality associations
Examined eight TyG-derived indices including TyG-BMI and TyG-WHR.
TyG-BMI showed a lower adjusted risk for all-cause mortality (HR 0.657, 95% CI 0.488–0.885) in quartile 4 compared to quartile 1.
Significant association between TyG-BMI and cardiovascular mortality (HR 0.477, 95% CI 0.281–0.808) in the same quartiles.
L-shaped associations between TyG-BMI and mortality risks were noted, especially in those with hypertension or cardiovascular disease.

Abstract

Background: Triglyceride-glucose (TyG)-related indices have been proposed as markers of metabolic dysfunction, but their associations with mortality among cancer survivors remain unclear. Methods: Using data from 1737 adult cancer survivors in the 1999–2018 NHANES, we analyzed eight TyG-derived indices: TyG combined with body mass index (TyG-BMI), weight-adjusted waist index (TyG-WWI), waist-to-height ratio (TyG-WHR), body roundness index (TyG-BRI), a body shape index (TyG-ABSI), conicity index (TyG-CI), and relative fat mass (TyG-RFM). Weighted Cox models and restricted cubic splines (RCS) were used to assess mortality associations. Results: TyG-BMI showed robust results in most analyses. Multivariable Cox models demonstrated a stepwise decline in both all-cause and cardiovascular mortality across the quartiles of TyG-related indices. Compared to quartile 1 of the TyG-BMI, quartile 4 exhibited a lower adjusted risk for all-cause mortality [hazard ratio (HR) 0.657, 95% confidence interval (CI) 0.488–0.885) and cardiovascular mortality (HR 0.477, 95% CI 0.281–0.808). The RCS curves revealed L-shaped associations between TyG-BMI and both all-cause and cardiovascular mortality risks. No significant association was observed between any of the indices and cancer-specific mortality in the overall population. Sensitivity analyses indicated that, in individuals with hypertension or cardiovascular disease, most of the TyG-BMI indices showed an L-shaped association with cancer-specific mortality for cancer survivors ( P < 0.05). Conclusions: This first investigation of TyG-related indices in cancer survivors highlights TyG-BMI as a promising composite marker integrating metabolic and body composition measures, and TyG-BMI may serve as a marker of metabolic and nutritional vulnerability for cancer survivors. Given the potential for reverse causality, these findings warrant confirmation in future prospective studies.

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