Prognostic Value of the Lung Immune Prognostic Index for Metastatic Non-Small Cell Lung Cancer Patients: A Chinese Cohort Study

Abstract

Background

Most cancer-related deaths around the globe are caused by lung cancer. The present treatments for metastatic non-small cell lung cancer (mNSCLC) are cytotoxic chemotherapy (CCT), targeted therapy (TT) and immunotherapy, but the benefit of the same regime varies greatly. Hence, it is important to identify biomarkers to predict the efficacy of modalities. Previous literature suggested certain parameters might be predictive factors. Nevertheless, the utility of these parameters is limited due to the types of solid tumors.

Purpose

The study aimed to examine whether the lung immune prognostic index (LIPI) was related to outcomes of CCT, immune checkpoint inhibitors (ICIs) and TT for mNSCLC patients.

Materials and Methods

A retrospective cohort study between September 2012 and May 2020 was conducted on 350 Chinese mNSCLC patients, including 147 patients receiving ICIs, 103 TT, and 100 CCT. The data were examined to analyze the prognostic value of LIPI among various treatments.

Main Outcomes and Measures

The associations between PFS and good, intermediate, or poor prognostic LIPI scores in ICIs, TT, and CCT were determined, respectively.

Results

In univariable analyses, there was a relevance between a good LIPI score and better PFS among patients receiving ICIs (HR, 0.81; 95% CI, 0.44–1.51), TT (HR, 0.35; 95% CI, 0.16–1.74), and CCT (HR, 0.39; 95% CI, 0.19–0.80). In multivariable analyses, the intermediate LIPI score was linked to better PFS only in patients receiving TT (HR, 0.31; 95% CI, 0.17–0.92) rather than ICIs (HR, 1.12; 95% CI, 0.66–2.45) or CCT (HR, 1.24; 95% CI, 0.49–4.55).

Conclusion

Baseline LIPI value is an important prognostic biomarker for mNSCLC patients treated with TT. Shorter PFS with TT was associated with poor baseline LIPI. Poor LIPI score may be considered as a promising indicator showing which patients are unlikely to respond well to TT. The prognostic value of LIPI can be more clearly determined through prospective clinical study.

Keywords:

• lung immune prognostic index
• metastatic non-small cell lung cancer
• prognostic value

Acknowledgments

This study was funded by Scientific Research Fund Project of Yunnan Provincial Department of Education (grant 2019J1290); Yunnan Fundamental Research Projects (grant NO. 202001AY070001-245); National Training Program for Innovative Talents of Traditional Chinese Medicine (grant [2019]128) and Yunnan Province High-level Health Technology Talent Training Project (grant H-2019077). Sponsors had no role in study design nor in preparation of the manuscript.

Disclosure

The authors report no conflicts of interest in this work.