Prognostic Value of the Lung Immune Prognostic Index in Metastatic Renal Cell Carcinoma: A Multicentre Cohort Study

Abstract

Background and Purpose: The Lung Immune Prognostic Index (LIPI), based on derived neutrophil-to-lymphocyte ratio (dNLR) and Lactate Dehydrogenase (LDH), is a recognized biomarker in various malignancies. However, its incremental value over the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) score in metastatic renal cell carcinoma (mRCC) remains debated. This study evaluated the prognostic role of LIPI in mRCC and its association with clinicopathological features. Methods: We retrospectively analyzed 304 mRCC patients treated between 2010 and 2023 at two oncology centers. Patients were stratified into good, intermediate, and poor LIPI groups. Survival outcomes were assessed using Kaplan–Meier and Cox regression. The prognostic performance of LIPI was compared and combined with the IMDC model using the Akaike Information Criterion (AIC). Results: Of 304 patients, 35.2% were good, 44.1% intermediate, and 17.8% poor LIPI risk. Poor LIPI was significantly associated with liver metastasis (p=0.009) and poor IMDC risk (p=0.001). Median overall survival was 45, 30, and 14 months for good, intermediate, and poor groups, respectively (p<0.001). While IMDC showed better model fit (AIC: 1547.2 vs 1560.0), adding LIPI to the IMDC model provided a significant incremental contribution (p=0.047). In the combined model , poor LIPI remained significantly associated with worse overall survival after adjustment for IMDC (HR=1.72, p=0.013). Conclusion: LIPI is a simple tool for prognostic stratification in mRCC, correlating with high-risk features like liver metastasis. Although IMDC remains the primary prognostic model, LIPI provides a modest but statistically significant incremental contribution, suggesting it captures additional biological information.

Keywords

• Renal Cancer
• Lung Immune Prognostic Index
• Prognosis
• Biomarkers
• Immunotherapy

Prognostic Value of the Lung Immune Prognostic Index in Metastatic Renal Cell Carcinoma: A Multicentre Cohort Study

Abstract

Amaç ve Kapsam : Türetilmiş nötrofil/lenfosit oranı (dNLR) ve Laktat Dehidrogenaz (LDH) düzeylerine dayanan Akciğer İmmün Prognostik İndeksi (LIPI), çeşitli malignitelerde tanınmış bir biyobelirteçtir. Ancak, metastatik böbrek hücreli karsinomda (mRCC) Uluslararası Metastatik Böbrek Hücreli Karsinom Veri Tabanı Konsorsiyumu (IMDC) skoruna kıyasla ek (inkremental) değeri tartışmalı kalmaya devam etmektedir. Bu çalışma, mRCC’de LIPI’nin prognostik rolünü ve klinikopatolojik özelliklerle olan ilişkisini değerlendirmiştir. Yöntem : 2010 ile 2023 yılları arasında iki onkoloji merkezinde tedavi edilen 304 mRCC hastası retrospektif olarak analiz edildi. Hastalar iyi, orta ve kötü LIPI gruplarına ayrıldı. Sağkalım sonuçları Kaplan–Meier ve Cox regresyonu kullanılarak değerlendirildi. LIPI’nin prognostik performansı Akaike Bilgi Kriteri (AIC) kullanılarak IMDC modeli ile karşılaştırıldı ve birleştirildi. Bulgular : 304 hastanın %35,2’si iyi, %44,1’i orta ve %17,8’i kötü LIPI risk grubundaydı. Kötü LIPI, karaciğer metastazı (p=0,009) ve kötü IMDC riski (p=0,001) ile anlamlı derecede ilişkiliydi. Ortanca genel sağkalım iyi, orta ve kötü gruplar için sırasıyla 45, 30 ve 14 aydı (p<0,001). IMDC daha iyi bir model uyumu gösterirken (AIC: 1547,2'ye karşı 1560,0), IMDC modeline LIPI’nin eklenmesi anlamlı bir ek katkı sağladı (p=0,047). Birleştirilmiş modelde kötü LIPI, IMDC’ye göre düzeltildikten sonra da daha kötü genel sağkalım ile anlamlı düzeyde ilişkili kalmaya devam etti (HR=1,72, p=0,013). Sonuç : LIPI, mRCC’de prognostik derecelendirme için basit bir araçtır ve karaciğer metastazı gibi yüksek riskli özelliklerle korelasyon göstermektedir. IMDC birincil prognostik model olmaya devam etmekle birlikte, LIPI mütevazı ancak istatistiksel olarak anlamlı bir ek katkı sunarak ek biyolojik bilgiler taşıdığını düşündürmektedir.

Keywords

• Böbrek Kanseri
• Akciğer İmmün Prognostik İndeksi
• Prognoz
• Biyobelirteçler
• İmmünoterapi

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