World Journal of Oncology, ISSN 1920-4531 print, 1920-454X online, Open Access
Article copyright, the authors; Journal compilation copyright, World J Oncol and Elmer Press Inc
Journal website https://wjon.elmerpub.com

Original Article

Volume 16, Number 5, October 2025, pages 509-524

Association Between Platelet-to-Lymphocyte Ratio and Insulin Resistance in Cancer Survivors: A Cross-Sectional Study Based on the NHANES 2005 - 2018

Figures

↓  Figure 1. Flowchart of the systematic selection process.
Figure 1.
↓  Figure 2. Non-linear association between PLR and IR assessed by HOMR-IR (a), QuICKI (b) and TyG index (c). The solid line represents adjusted ORs, and light blue area represents the 95% CI. The reference point was set at a PLR value of 130.53 across all analyses. All models were adjusted for age, gender, race/ethnicity, marital status, education, family PIR, smoking status, alcohol consumption, sleep duration, physical activity, BMI, history of diabetes status, CVD and hypertension. PLR: platelet-to-lymphocyte ratio; IR: insulin resistance; HOMA-IR: homeostatic model assessment for insulin resistance; QUICKI: quantitative insulin sensitivity check index; TyG: triglyceride-glucose; PIR: poverty income ratio; BMI: body mass index; CVD: cardiovascular disease; OR: odds ratio; CI: confidence interval.
Figure 2.
↓  Figure 3. Subgroup analysis of the association between PLR and IR assessed by HOMA-IR (a), QUICKI (b), and the TyG index (c). For quartile analysis, odds ratios (ORs) with 95% confidence intervals (CI) represent the comparison of the highest quartile (Q4) versus the lowest quartile (Q1). All OR and interaction measures were adjusted for age, sex, race/ethnicity, marital status, education level, family PIR, smoking status, alcohol use, sleep duration, physical activity, BMI, and comorbidities (CVD and hypertension), with the stratification component in question being excluded. PLR: platelet-to-lymphocyte ratio; IR: insulin resistance; HOMA-IR: homeostatic model assessment for insulin resistance; QUICKI: quantitative insulin sensitivity check index; TyG: triglyceride-glucose; PIR: poverty income ratio; BMI: body mass index; CVD: cardiovascular disease.
Figure 3.
↓  Figure 4. ROC curve analysis of PLR for predicting IR assessed by HOMA-IR (a), QUICKI (b), and the TyG index (c). PLR: platelet-to-lymphocyte ratio; IR: insulin resistance; HOMA-IR: homeostatic model assessment for insulin resistance; QUICKI: quantitative insulin sensitivity check index; TyG: triglyceride-glucose; ROC: receiver operating characteristic; AUC: area under the curve.
Figure 4.

Tables

↓  Table 1. Characteristics of Study Participants Stratified by Insulin Resistance Indicators
 
Characteristics Total (n = 1,418) HOMA-IR QUICKI TyG index
< 2.5 (n = 762) ≥ 2.5 (n = 626) P value ≥ 0.33 (n = 710) < 0.33 (n = 708) P value < 4.68 (n = 718) ≥ 4.68 (n = 700) P value
Non-normally distributed continuous variables are presented as median (Q1, Q3), and categorical variables are reported as n (weighted %). P values are calculated using one-way ANOVA for continuous variables and Chi-square test for categorical variables. PLR: platelet-to-lymphocyte ratio; HOMA-IR: homeostatic model assessment for insulin resistance; QUICKI: quantitative insulin sensitivity check index; TyG: triglyceride-glucose; PIR: poverty income ratio; PA: physical activity; BMI: body mass index; CVD: cardiovascular disease; ANOVA: analysis of variance.
PLR, median (Q1, Q3) 130.5 (101.3, 168.1) 125.28 (96.93, 162.97) 137.14 (107.03, 173.33) < 0.001 123.51 (96.22, 161.42) 137.74 (108.22, 174.30) < 0.001 126.00 (96.32, 163.28) 135.13 (106.39, 172.36) 0.002
Age, years, median (Q1, Q3) 69.0 (58.0, 78.0) 69.00 (57.00, 79.00) 68.00 (58.00, 76.00) 0.891 70.00 (57.75, 79.00) 68.00 (58.00, 76.00) 0.849 68.00 (56.75, 78.00) 69.00 (59.25, 78.00) 0.004
Gender, n (%) 0.046 0.064 0.222
  Male 654 (41.6) 296 (39.1) 358 (44.3) 322 (39.4) 332 (44.3) 328 (40.1) 326 (43.3)
  Female 764 (58.4) 360 (61.0) 404 (55.7) 386 (60.6) 378 (55.8) 372 (59.9) 392 (56.7)
Race/ethnicity, n (%) 0.002 0.003 0.253
  Mexican American 106 (2.8) 32 (1.6) 74 (4.1) 34 (1.7) 72 (4.21) 40 (2.3) 66 (3.4)
  Other Hispanic 98 (2.8) 35 (2.6) 54 (3.0) 35 (2.4) 54 (3.2) 44 (3.1) 45 (2.4)
  Non-Hispanic White 964 (85.2) 489 (88.8) 475 (81.6) 533 (88.5) 44 (81.4) 459 (84.2) 505 (86.3)
  Non-Hispanic Black 181 (5.3) 65 (3.9) 116 (6.6) 77 (4.2) 104 (6.5) 119 (6.3) 64 (4.1)
  Other race 78 (3.9) 35 (3.1) 43 (4.7) 39 (3.2) 39 (4.8) 40 (4.0) 38 (3.8)
Marital status, n (%) 0.656 0.307 0.091
  Never married 81 (4.9) 37 (5.4) 44 (4.4) 43 (5.7) 38 (4.0) 47 (5.4) 34 (4.4)
  Married/living with partner 892 (68.3) 408 (67.5) 484 (69.1) 441 (67.6) 451 (69.1) 441 (70.2) 451 (66.3)
  Widowed/divorced/separated 445 (26.8) 211 (27.1) 234 (26.5) 224 (26.7) 221 (27.0) 212 (24.4) 233 (29.4)
Education, n (%) 0.033 0.029 0.005
  Less than high school 301 (12.9) 124 (11.0) 177 (14.8) 133 (11.1) 168 (15.0) 125 (10.5) 176 (15.4)
  Above high school 1,117 (87.1) 532 (89.0) 585 (85.2) 575 (88.9) 542 (85.0) 575 (89.5) 542 (84.6)
Family PIR, n (%) < 0.001 < 0.001 < 0.001
  < 1.3 331 (14.7) 127 (11.4) 204 (18.0) 137 (11.6) 194 (18.2) 143 (12.6) 188 (17.0)
  1.3 - 3.5 572 (36.1) 261 (33.6) 311 (38.7) 289 (34.6) 283 (37.8) 276 (31.3) 305 (41.2)
  ≥ 3.5 515 (49.2) 268 (55.1) 247 (43.3) 282 (53.8) 233 (44.0) 290 (56.1) 225 (41.9)
Smoking status, n (%) 0.697 0.956 0.025
  No 663 (48.7) 314 (49.3) 349 (48.2) 334 (48.8) 329 (48.7) 344 (51.6) 319 (45.7)
  Yes 755 (51.3) 342 (50.8) 413 (51.8) 374 (51.2) 381 (51.3) 356 (48.4) 399 (54.4)
Alcohol use, n (%) 0.001 < 0.001 0.204
  No 354 (20.4) 141 (16.9) 232 (24.0) 150 (16.8) 204 (24.6) 161 (19.1) 193 (21.8)
  Yes 1,064 (79.6) 515 (83.1) 549 (76.0) 558 (83.2) 506 (75.4) 539 (80.9) 525 (78.2)
Sleep duration, h/night, n (%) 0.017 0.006 0.042
  < 7 428 (27.3) 182 (24.6) 246 (30.1) 194 (24.1) 234 (31.1) 193 (24.5) 235 (30.3)
  7.0 - 9.0 793 (60.8) 388 (64.4) 405 (57.1) 418 (64.4) 375 (56.5) 408 (63.6) 385 (57.8)
  ≥ 9 197 (11.9) 86 (11.0) 111 (12.8) 96 (11.5) 101 (12.4) 99 (11.9) 98 (11.9)
PA, MET-min/week, n (%) < 0.001 < 0.001 < 0.001
  < 600 698 (43.7) 296 (38.5) 402 (49.0) 319 (38.4) 379 (49.9) 318 (37.8) 380 (50.0)
  ≥ 600 720 (56.3) 360 (61.5) 360 (51.0) 389 (61.6) 331 (50.1) 382 (62.2) 338 (50.0)
BMI, kg/m2, n (%) < 0.001 < 0.001 < 0.001
  < 18.5 20 (1.8) 18 (3.2) 2 (0.3) 19 (3.2) 1 (0.1) 17 (3.1) 3 (0.4)
  18.5 < 25 377 (28.3) 292 (45.0) 85 (11.1) 303 (43.8) 74 (10.1) 261 (38.6) 116 (17.1)
  25 < 30 486 (34.1) 243 (37.6) 243 (30.6) 270 (37.9) 216 (29.7) 231 (33.3) 255 (35.0)
  ≥ 30 535 (35.8) 103 (14.2) 432 (58.0) 116 (15.2) 419 (60.1) 191 (25.0) 344 (47.5)
Diabetes mellitus, n (%) < 0.001 < 0.001 < 0.001
  No 979 (76.4) 559 (90.8) 420 (61.6) 599 (90.3) 380 (60.1) 589 (88.3) 390 (63.6)
  Yes 439 (23.6) 97 (9.2) 342 (38.4) 109 (9.7) 330 (39.9) 111 (11.7) 328 (36.4)
CVD, n (%) < 0.001 < 0.001 0.002
  No 1,066 (80.0) 516 (83.8) 550 (76.2) 559 (83.9) 507 (75.5) 553 (83.2) 513 (76.7)
  Yes 352 (20.0) 140 (16.2) 212 (23.8) 149 (16.1) 203 (24.5) 147 (16.8) 205 (23.4)
Hypertension, n (%) < 0.001 < 0.001 < 0.001
  No 596 (48.2) 339 (58.4) 257 (37.7) 363 (58.2) 233 (36.4) 340 (56.2) 256 (39.6)
  Yes 822 (51.8) 317 (41.6) 257 (62.3) 345 (41.8) 477 (63.6) 360 (43.8) 462 (60.4)

 

↓  Table 2. The Association Between PLR and Insulin Resistance Stratified by HOMA-IR, QUICKI and TyG Index
 
PLR quartiles By HOMA-IR By QUICKI By TyG index
Model 1 Model 2 Model 3 Model 1 Model 2 Model 3 Model 1 Model 2 Model 3
HR (95% CI) P value HR (95% CI) P value HR (95% CI) P value HR (95% CI) P value HR (95% CI) P value HR (95% CI) P value HR (95% CI) P value HR (95% CI) P value HR (95% CI) P value
Model 1: non-adjusted model; Model 2: adjusted for age, sex, race/ethnicity, marital status, and family PRI; Model 3: adjusted for Model 1 covariates plus smoking status, alcohol use, sleep duration, physical activity, BMI, CVD and hypertension. PLR: platelet-to-lymphocyte ratio; HOMA-IR: homeostatic model assessment for insulin resistance; QUICKI: quantitative insulin sensitivity check index; TyG: triglyceride-glucose; BMI: body mass index; CVD: cardiovascular disease; HR: hazard ratio; CI: confidence interval; Ref: reference.
Q1 (< 101.33) Ref Ref Ref Ref Ref Ref Ref Ref Ref
Q2 (101.33 - 130.51) 1.19 (0.81, 1.75) 0.375 1.18 (0.81, 1.73) 0.393 1.11 (0.75, 1.83) 0.476 1.22 (0.84, 1.79) 0.298 1.23 (0.84, 1.79) 0.296 1.25 (0.81, 1.95) 0.326 1.57 (1.07, 2.31) 0.021 1.54 (1.05, 2.28) 0.029 1.61 (1.05, 2.46) 0.027
Q3 (130.51 - 168.18) 1.43 (0.96, 2.13) 0.075 1.37 (0.93, 2.03) 0.111 1.39 (0.89, 2.15) 0.144 1.56 (1.05, 2.32) 0.026 1.51 (1.03, 2.23) 0.037 1.62 (1.05, 2.51) 0.030 1.70 (1.15, 2.53) 0.008 1.65 (1.11, 2.46) 0.013 1.69 (1.09, 2.62) 0.017
Q4 (≥ 168.18) 1.64 (1.11, 2.13) 0.013 1.58 (1.07, 2.35) 0.223 1.40 (0.90, 2.14) 0.140 1.80 (1.21, 2.68) 0.003 1.75 (1.17, 2.60) 0.006 1.61 (1.02, 2.53) 0.040 1.67 (1.13, 2.47) 0.010 1.67 (1.12, 2.49) 0.012 1.56 (1.02, 2.45) 0.035
P for trend 1.18 (1.04, 1.34) 0.008 1.16 (1.03, 1.32) 0.017 1.13 (0.98, 1.30) 0.091 1.22 (1.08, 1.39) 0.002 1.21 (1.06, 1.37) 0.003 1.19 (1.03, 1.38) 0.021 1.17 (1.04, 1.33) 0.012 1.17 (1.03, 1.33) 0.014 1.15 (1.01, 1.31) 0.039

 

↓  Table 3. ROC Curve Analysis of PLR for Predicting Insulin Resistance Assessed by HOMA-IR, QUICKI, and the TyG Index
 
IR indicator Variable Cutoff value Sensitivity Specificity AUC (95% CI)
HOMA-IR PLR 124 0.525 0.588 0.561 (0.531, 0.591)
QUICKI PLR 132 0.617 0.562 0.616 (0.587, 0.645)
TyG index PLR 137 0.606 0.587 0.622 (0.593, 0.651)