Validation of modificated of lung immune prognostic index in patients with metastatic NSCLC treated by immunotherapy

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

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. 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. 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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