Prognostic Value of Triglyceride-Glucose Index in Acute Myeloid Leukemia: A Retrospective Study
Authors: Ding Yangyang , Li Fengli , Zhu Jinli , Jiao Xunyi , Liu Zelin , Liao Ya , Tao Qianshan , Hu Linhui , Xiong Shudao , Zhai Zhimin 
Published: December 2024

Background: Acute myeloid leukemia (AML) is an incurable hematological malignancy. The triglyceride-glucose (TYG) index is a surrogate marker for insulin resistance, but its relationship with AML prognosis remains unclear. This study aimed to investigate the prognostic value of the TYG index in AML.

Methods: We retrospectively analyzed laboratory test data of 158 initially diagnosed AML patients and calculated the TYG index. The association between TYG index and patient prognosis was evaluated by survival curve. We constructed a prognostic nomogram through multivariate Cox regression analyses, and its performance was evaluated using calibration curves, the C-index, and the area under the curve (AUC).

Results: A total of 158 AML patients, aged between 18 and 83 years (mean age 50.48 years), were included in this study from January 2017 to June 2023. Of these, 131 patients (82.9%) achieved CR after one or two courses of induction chemotherapy. 81 patients (51.27%) were male, 71 patients (44.94%) relapsed and 89 patients (56.32%) died at the end of follow-up. The median follow-up time was 27 months. According to the 2017 European Leukemia Network (ELN2017) genetic risk stratification, 44 (27.85%), 59 (37.34%), and 55 (34.81%) of patients were classified into favorable, intermediate, and adverse risk groups, respectively. Fasting glucose and fasting triglycerides were measured at diagnosis, with a median TYG index level of 1.28. Patients were divided into high and low TYG index groups based on median value. We investigated the impact of TYG index on RFS and OS. Patients with high TYG index had significantly inferior RFS and OS compared to those with low TYG index (5-year RFS: 52.9% vs. 16.2%, log-rank P&lt;0.001; 5-year OS: 42.6% vs. 20.8%, log-rank P&lt;0.01). We further investigated whether the TYG index could stratify patients within each ELN risk group. In the intermediate risk group, patients with high TYG index also had significantly inferior RFS and OS compared to those with low TYG index patients (5-year RFS: 53.6% vs. 14.4%, log-rank P&lt;0.01; 5-year OS: 43.9% vs. 23.2%, log-rank P&lt;0.05). Similar results were observed in the adverse risk groups for RFS (2-year RFS: 51.5% vs. 9.3%, log-rank P&lt;0.05) but not for OS. Although there was no statistically significant difference in the favorable risk group, there was a trend toward worse RFS and OS for patients with high TYG index. In particular, among the 22 patients with AML-ETO positivity in the favorable risk group, those with high TYG index had significantly inferior RFS and OS compared to those with low TYG index (3-year RFS: 91.7% vs. 14.6%, log-rank P&lt;0.01; 5-year OS: 85.1% vs. 28.6%, log-rank P&lt;0.05). Multivariate analysis showed that TYG index was an independent prognostic factor for both OS (HR 1.502, 95%CI 1.139-1.981) and RFS (HR 1.526, 95%CI 1.110-2.099) in AML patients. A new prognostic nomogram was developed, incorporating the TYG index, age, and ELN2017. This nomogram demonstrated high predictive accuracy for 1-year, 3-year, and 5-year OS in AML patients, with AUCs of 0.789, 0.764, and 0.798, respectively.

Conclusions: The TYG index is an independent prognostic factor for AML. The new nomogram, which combines TYG index, age, and ELN2017 genetic risk stratification, provides a quick and simple method with high clinical value for predicting the prognosis of AML patients.