Background: Although insulin resistance has been implicated in cancer development, its specific role in lung cancer remains unclear. The metabolic score for insulin resistance (METS-IR) is a novel surrogate marker that integrates multiple metabolic parameters and has demonstrated strong predictive value for metabolic disorders. This study aimed to investigate the association between METS-IR and lung cancer incidence in a large-scale nationwide cohort. Methods: We analyzed data from 322,624 participants of the National Health Insurance Service-National Health Screening Cohort in Republic of Korea. Participants were stratified into METS-IR quartiles, and lung cancer incidence was assessed using Kaplan–Meier survival curves and Cox proportional hazards regression models. Subgroup analyses were conducted to examine the impact of body composition, particularly sarcopenia, on the association between METS-IR and lung cancer. Results: Over a median follow-up of 9.5 years, 5912 lung cancer cases were identified. Lung cancer incidence per 1000 person-years was highest in the lowest METS-IR quartile (Q1: 2.27) and decreased across quartiles (Q2: 1.93, Q3: 1.81, Q4: 1.72). In fully adjusted Cox regression models, using Q1 as the reference group, higher METS-IR quartiles were associated with a significantly lower risk of lung cancer (Q2: HR 0.91, 95% CI 0.85–0.98; Q3: HR 0.86, 95% CI 0.79–0.92; Q4: HR 0.80, 95% CI 0.74–0.86;pfor trend < 0.001). Subgroup analyses revealed that the inverse association was more pronounced in male participants and individuals with a low body mass index. Conclusions: In this nationwide cohort study, we observed a significant inverse association between METS-IR and lung cancer risk. However, METS-IR showed limitations in fully explaining lung cancer risk based on insulin resistance alone. These findings highlight the need for future studies incorporating body composition assessments to better evaluate metabolic vulnerability.
背景：尽管胰岛素抵抗被认为与癌症发生相关，但其在肺癌中的具体作用尚不明确。胰岛素抵抗代谢评分（METS-IR）是一种整合多项代谢参数的新型替代标志物，已证明对代谢紊乱具有较强预测价值。本研究旨在通过大规模全国性队列探讨METS-IR与肺癌发病率之间的关联。 方法：我们分析了韩国国民健康保险服务-国民健康筛查队列中322,624名参与者的数据。将参与者按METS-IR四分位数分层，采用Kaplan-Meier生存曲线和Cox比例风险回归模型评估肺癌发病率。通过亚组分析探讨身体成分（特别是肌肉减少症）对METS-IR与肺癌关联的影响。 结果：在中位随访9.5年期间，共发现5912例肺癌病例。每1000人年肺癌发病率在最低METS-IR四分位数组（Q1：2.27）最高，并随四分位数升高呈递减趋势（Q2：1.93，Q3：1.81，Q4：1.72）。在完全校正的Cox回归模型中，以Q1为参照组，较高的METS-IR四分位数与显著降低的肺癌风险相关（Q2：HR 0.91，95% CI 0.85–0.98；Q3：HR 0.86，95% CI 0.79–0.92；Q4：HR 0.80，95% CI 0.74–0.86；趋势性p值<0.001）。亚组分析显示这种负向关联在男性参与者及低体重指数个体中更为显著。 结论：在这项全国性队列研究中，我们观察到METS-IR与肺癌风险存在显著负相关。然而，METS-IR在单独基于胰岛素抵抗解释肺癌风险方面存在局限性。这些发现提示未来研究需要纳入身体成分评估以更准确评估代谢脆弱性。
肿瘤(癌症)患者之家