World J Oncol

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 000, Number 000, August 2025, pages 000-000

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

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 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 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.

**Table 1.** Characteristics of Study Participants Stratified by Insulin Resistance Indicators
Characteristics	Total (n = 1,418)	HOMA-IR	QUICKI	TyG index
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 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

< 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

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

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

< 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

< 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

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

0.002

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

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: 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 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

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)

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)