medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2025-436medsovet-9687Research ArticleИММУНОТЕРАПИЯIMMUNOTHERAPYВалидация модифицированного легочного иммунного прогностического индекса у пациентов с метастатическим немелкоклеточным раком легкого, получающих иммунотерапиюValidation of modificated of lung immune prognostic index in patients with metastatic NSCLC treated by immunotherapyhttps://orcid.org/0000-0002-0620-2696ЮдинД. И.YudinD. I.

Юдин Денис Иванович - к.м.н., старший научный сотрудник.

115478, Москва, Каширское шоссе, д. 24

Denis I. Yudin - Cand. Sci. (Med.), Senior Researcher, Department of Antitumor Drug Therapy No. 3, Drug Treatment Department, Blokhin National Medical Research Center of Oncology.

24, Kashirskoye Shosse, Moscow, 115478

yudinden@mail.ruhttps://orcid.org/0000-0003-4469-502XЛактионовК. К.LaktionovK. K.

Лактионов Константин Константинович - д.м.н., профессор кафедры онкологии и лучевой терапии лечебного факультета, РНИМУ им. Н.И. Пирогова; заведующий отделением противоопухолевой лекарственной терапии №3 отдела лекарственного лечения, НМИЦ онкологии им. Н.Н. Блохина.

117997, Москва, ул. Островитянова, д. 1; 115478, Москва, Каширское шоссе, д. 24

Konstantin K. Laktionov - Dr. Sci. (Med.), Professor of the Department of Oncology and Radiation Therapy Institute of Surgery, Pirogov Russian National Research Medical University; Head of the Department of Antitumor Drug Therapy No. 3, Department of Drug Treatment, Blokhin National Medical Research Center of Oncology.

1, Ostrovityanov St., Moscow, 117997; 24, Kashirskoe Shosse, Moscow, 115478

lkoskos@mail.ruhttps://orcid.org/0000-0002-6323-511XДжанянИ. А.DzhanyanI. A.

Джанян Ирина Анатольевна - врач-онколог.

115478, Москва, Каширское шоссе, д. 24

Irina A. Dzhanyan - Oncologist, Department of Antitumor Drug Therapy No. 3, Drug Treatment Department, Blokhin National Medical Research Center of Oncology.

24, Kashirskoye Shosse, Moscow, 115478

i-dzhanyan@mail.ruhttps://orcid.org/0000-0002-1357-0956КузьминовА. Е.KuzminovA. E.

Кузьминов Александр Евгеньевич - к.м.н., научный сотрудник отделения противоопухолевой лекарственной терапии N 3 отдела лекарственного лечения.

115478, Москва, Каширское шоссе, д. 24

Alexander E. Kuzminov - Cand. Sci. (Med.), Researcher of Cancer Drug Therapy Department No. 3, Blokhin National Medical Research Center of Oncology.

24, Kashirskoye Shosse, Moscow, 115478

alexkouzminov@mail.ruhttps://orcid.org/0000-0002-6244-4294БредерВ. В.BrederV. V.

Бредер Валерий Владимирович - д.м.н., ведущий научный сотрудник.

115478, Москва, Каширское шоссе, д. 24

Valeriy V. Breder - Dr. Sci. (Med.), Lead Research Associate of the Oncological Department of Medicinal Methods of Treatment (Chemotherapeutic) No. 3, Blokhin National Medical Research Center of Oncology.

24, Kashirskoye Shosse, Moscow, 115478

vbreder@yandex.ruhttps://orcid.org/0000-0001-7322-0125ГороховА. Е.GorokhovA. E.

Горохов Артур Евгеньевич - врач-онколог.

115478, Москва, Каширское шоссе, д. 24

Arthur E. Gorokhov - Oncologist, Department of Antitumor Drug Therapy No. 3, Drug Treatment Department, Blokhin National Medical Research Center of Oncology.

4, Kashirskoye Shosse, Moscow, 115478

arthur@gorokhov.meНациональный медицинский исследовательский центр онкологии имени Н.Н. БлохинаРоссияBlokhin National Medical Research Center of OncologyRussian FederationНациональный медицинский исследовательский центр онкологии имени Н.Н. Блохина; Российский национальный исследовательский медицинский университет имени Н.И. ПироговаРоссияBlokhin National Medical Research Center of Oncology; Pirogov Russian National Research Medical UniversityRussian Federation2025010120260211219Copyright © Юдин Д.И., Лактионов К.К., Джанян И.А., Кузьминов А.Е., Бредер В.В., Горохов А.Е., 20262026Юдин Д.И., Лактионов К.К., Джанян И.А., Кузьминов А.Е., Бредер В.В., Горохов А.Е.Yudin D.I., Laktionov K.K., Dzhanyan I.A., Kuzminov A.E., Breder V.V., Gorokhov A.E.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/9687Введение

Введение. Легочный иммунный прогностический индекс (LIPI) является одной из доступных моделей для прогнозирования результатов лечения ингибиторами иммунных контрольных точек для пациентов с метастатическим немелкоклеточным раком легкого (НМРЛ). Недостатком модели является наличие группы с неопределенным прогнозом. Данное одноцентровое ретроспективное исследование было проведено с целью валидации модифицированного легочного иммунного прогностического индекса (mLIPI) для более точного прогнозирования ответа на иммунотерапию и исключения группы неопределенного прогноза из предлагаемой модели. Первичной конечной точкой была выживаемость без прогрессирования (ВБП). Цель. Валидация модифицированного варианта легочного иммунного прогностического индекса (mLIPI) для более точного прогнозирования ответа на иммунотерапию.

Материалы и методы

Материалы и методы. Исходные данные по отношению нейтрофилов к лимфоцитам, уровню лактатдегидрогеназы (ЛДГ), гемоглобина, тромбоцитов и фибриногена были собраны у 195 пациентов, получавших иммунотерапию в монорежиме или в комбинации с химиотерапией в НМИЦ онкологии имени Н.Н. Блохина. Был проведен однофакторный и многофакторный анализ ВБП. Медиана времени наблюдения составила 39,5 мес.

Результаты

Результаты. При однофакторном анализе достоверно ассоциировались с худшей выживаемостью без прогрессирования уровень гемоглобина ниже 110 г/л (ОР = 1,78, 95% ДИ 1,51–6,46), число тромбоцитов больше 2 нормальных значений (ОР = 4,97, 95% ДИ 1,19–20,63), отношение нейтрофилов к лимфоцитам 3 и более (ОР = 1,39, 95% ДИ 1,02–1,89), уровень лактатдегидрогеназы выше нормальных значений (ОР = 1,54, 95% ДИ 1,1–2,14), уровень фибриногена больше 2 нормальных значений (ОР = 1,96, 95% ДИ 1,06–3,64). При однофакторном и многофакторном анализе сочетание любых 2 и более факторов достоверно ассоциировалось с худшей выживаемостью без прогрессирования (группа «плохого» прогноза mLIPI): ОР = 2,04 (95% ДИ 1,43–2,94) и ОР = 2,26 (95% ДИ 1,55–3,32) соответственно. При этом из 44 пациентов с mLIPI 2 и более у 19 (44%) оценка LIPI составила 1 балл (группа промежуточного прогноза LIPI). Медиана ВБП для групп «хорошего» и «плохого» прогноза mLIPI составила 8,4 мес. (95% ДИ 6,6–10,2) и 4 мес. (95% ДИ 2,4–5,6) (p < 0,001) соответственно. Трехлетняя ВБП для групп «хорошего» и «плохого» прогноза mLIPI составила 24,5 и 3,4% соответственно.

Выводы

Выводы. Определение базового mLIPI имеет предиктивное значение. Сочетание любых 2 изученных показателей (не только отношение нейтрофилов к лимфоцитам 3 и более и повышенный уровень ЛДГ) коррелирует с худшими результатами иммунотерапии у пациентов с метастатическим НМРЛ.

Introduction

Introduction. A lung immune prognostic index (LIPI) is one of the available models that showed association with immune checkpoint inhibitors (ICI) outcomes. The disadvantage of this model is the presence of intermediate prognostic group. This single-center retrospective study aims to validate the modified lung immune prognostic index (mLIPI) to more accurately predict of the response to immunotherapy and exclusion of intermediate prognostic group from the model. The primary endpoint was progression free survival (PFS).

Aim

Aim. Validation of modified lung immune prognostic index (mLIPI) to more accurately predict of the response to immunotherapy.

Materials and methods

Materials and methods. Baseline neutrophil-to-lymphocyte ratio, lactate dehydrogenase, hemoglobin, platelets, and fibrinogen level were collected from 195 patients treated with ICI in monotherapy or combination in N.N. Blokhin NMRCO. Univariate and multivariate subgroups analysis by Cox regression model was performed. The median follow-up time was 39.5 months.

Results

Results. In univariate analysis hemoglobin levels below 110 g/l (HR = 1.78, 95% CI 1.51–6.46), platelet count greater than 2 normal values (HR = 4.97, 95% CI 1.19–20.63), neutrophil-to-lymphocyte ratio of 3 or more (HR = 1.39, 95% CI 1.02–1.89), lactate dehydrogenase level is higher than normal values (HR = 1.54, 95% CI 1.1–2.14) and fibrinogen level is greater than 2 normal values (HR = 1.96, 95% CI 1.06–3.64) were significantly associated with worse PFS. In univariate and multivariate analysis, a combination of any 2 or more factors was significantly associated with worse PFS (“poor” mLIPI prognosis group): HR = 2.04 (95% CI 1.43–2.94) and HR = 2.26 (95% CI 1.55–3.32), respectively. At the same time, out of 44 patients with mLIPI 2 or more, 19 (44%) had a LIPI score of 1 (intermediate prognosis group LIPI). The median PFS for the “good” and “poor” mLIPI prognosis groups was 8.4 months (CI 95% 6.6–10.2) and 4 months (CI 95% 2.4–5.6) (p < 0.001), respectively. The 3-year PFS for the “good” and “poor” mLIPI prognosis groups was 24.5 and 3.4% respectively.

Conclusions

Conclusions. The basic mLIPI score has a predictive value. The combination of any two unfavorable factors (not only the ratio of neutrophils to lymphocytes and LDH level) significantly correlates with worse immunotherapy outcomes in patients with metastatic NSCLC.

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The authors declare that there are no conflicts of interest present.