Stability of the CMI-ALS axis in prostate cancer patients: a new target for prognostic assessment and treatment optimization

Background: The Cardiometabolic index (CMI) is used to assess individual cardiovascular metabolic health status and risk of metabolic disorders. Allostatic load score (ALS) quantifies the body’s physiological response to stress. This study aimed to investigate the relationship between the CMI and ALS in patients with prostate cancer using data from the National Health and Nutrition Examination Survey (NHANES). Methods: A total of 139 patients with prostate cancer were included in the analysis. Receiver operating characteristic (ROC) curve and decision curve analysis (DCA) were employed to assess the predictive accuracy and clinical net benefit. Multivariate linear regression was conducted to evaluate the relationship between CMI and ALS. Additionally, various analytical techniques, including quantile regression and logistic regression, were utilized to verify the stability and independence of their relationship. Collinearity, partial correlation, stepwise linear regression, multivariate regression, and mediation effect analyses were performed to examine whether the shared factor high-density lipoprotein cholesterol (HDL-C) influenced the CMI-ALS relationship. Results: The area under the curve (AUC) for CMI in predicting ALS was 0.650, indicating CMI can distinguish positive and negative samples more accurately than a random guess (AUC: 0.500), and has predictive ability. DCA indicated a clinical net benefit within the threshold probability range of 0.25 to 0.61. A positive relationship between CMI and ALS was observed (β [95% Confidence interval (CI)]: 0.598 [0.319, 0.877]). The relationship was found to be both stable and independent (all p < 0.05), unaffected by confounding factors. Furthermore, this relationship was not attributable to shared variables, confirming that CMI independently contributed to ALS (all p < 0.05). Conclusions: The study demonstrated a positive relationship between CMI and ALS in patients with prostate cancer. The find highlights the importance of monitoring CMI in those patients for early clinical intervention to mitigate allostatic load.