The triglyceride-glucose index shows promise as a novel prognostic marker for advanced hepatocellular carcinoma

This commentary critically appraises the study by Li <i>et al</i> which pioneered the exploration of the triglyceride-glucose (TyG) index as a prognostic marker in hepatitis B virus-related advanced hepatocellular carcinoma patients undergoing combined camrelizumab and lenvatinib therapy. While we acknowledge the study's clinical relevance in proposing an easily accessible metabolic biomarker, we delve into the mechanistic plausibility linking insulin resistance to immunotherapy response and angiogenic inhibition. We further critically examine the methodological limitations, including the retrospective design, the population-specific TyG cut-off value, and unaddressed metabolic confounders. We highlight the imperative for future research to validate its utility across diverse etiologies and treatment settings, and to unravel the underlying immunometabolic pathways.