Prognostic Value of the Lung Immune Prognostic Index for Progression-Free Survival and One-Year Survival in Advanced Non-Small Cell Lung Cancer Treated with Platinum-Based Chemotherapy
DOI:
https://doi.org/10.26911/theijmed....998Abstract
Background: Evidence regarding the prognostic value of the Lung Immune Prognostic Index (LIPI) in Indonesian patients with advanced non-small cell lung cancer (NSCLC) receiving platinum-based chemotherapy remains limited. This study aimed to evaluate baseline LIPI for progression-free survival (PFS) and one-year survival in patients with stage IV NSCLC receiving platinum-based chemotherapy.
Subjects and Method: This retrospective cohort included 111 patients with pathologically confirmed stage IV NSCLC receiving platinum-based chemotherapy at Dr. Moewardi Hospital, Surakarta, Indonesia. Records from January 2023 to June 2025 were sampled consecutively. Baseline LIPI was the independent variable; PFS and one-year survival were the dependent variables; and clinical factors were covariates. LIPI was calculated from pretreatment leukocyte and neutrophil counts and serum lactate dehydrogenase measured with the Mindray BS-600M before the first chemotherapy cycle. Progression was determined using RECIST 1.1 or the treating physician's assessment, and survival status was obtained from records and telephone follow-up. Kaplan-Meier, log-rank, and Cox regression analyses were used.
Results: Good, intermediate, and poor LIPI were observed in 27 (24.3%), 53 (47.7%), and 31 (27.9%) patients, respectively. Median PFS was 272, 141, and 144 days across these groups, without a significant overall difference (p= 0.062). LIPI was not independently associated with PFS (overall p= 0.162); M1c2 metastasis independently predicted progression (aHR= 1.94; 95% CI=1.09 to 3.43; p= 0.024). One-year survival differed across LIPI groups (p=0.038), but LIPI was not independently associated with mortality after adjustment (overall p=0.274). Squamous cell carcinoma independently predicted one-year mortality relative to adenocarcinoma (aHR= 2.62; 95% CI=1.46 to 4.69; p=0.001).
Conclusion: Baseline LIPI stratified one-year survival but was not an independent predictor of PFS or one-year mortality after multivariable adjustment. Metastatic burden and histopathology provided stronger independent prognostic information in this cohort.
Keywords:
lung cancer, platinum chemotherapy, progression-free survival, survival
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References
Abernethy AP, Arunachalam A, Burke T, McKay C, Cao X, Sorg R, et al. (2017). Real-world first-line treatment and overall survival in non-small cell lung cancer without known EGFR mutations or ALK rearrangements in a US community oncology setting. PLoS One. 12(6):e0178420. https://doi.org/10.1371/journal.pone.0178420.
Andarini S, Santoso AA, Arfiansyah MA, Syahruddin E, Zaini J, Putra AC, et al. (2024). Indonesian society of respirology position paper on lung cancer control in Indonesia. J Respirologi Indones. 44(4):1–5. https://doi.org/10.36497/jri.v44i4.884.
Andarini S, Syahruddin E, Aditya N, Zaini J, Kurniawan FD, Ermayanti S, et al. (2023). Indonesian society of respirology consensus statement on lung cancer screening and early detection in Indonesia. J Respirologi Indones. 43(2):144–150. https://doi.org/10.36497/jri.v43i2.455.
Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, et al. (2024). Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 74(3):229–263. https://doi.org/10.3322/caac.21834.
Huang L, Han H, Zhou L, Chen X, Xu Q, Xie J, et al. (2021). Evaluation of the lung immune prognostic index in non-small cell lung cancer patients treated with systemic therapy: a retrospective study and meta-analysis. Front Oncol. 11:1–11. https://doi.org/10.3389/fonc.2021.670230.
Jeon H, Wang S, Song J, Gill H, Cheng H (2025). Update 2025: management of non-small-cell lung cancer. Lung. 203(1). https://doi.org/10.1007/s00408-025-00801-x.
Ji Y, Zhang Y, Liu S, Li J, Jin Q, Wu J, et al. (2025). The epidemiological landscape of lung cancer: current status, temporal trend and future projections based on the latest estimates from GLOBOCAN 2022. J Natl Cancer Cent. 5(3):278–286. https://doi.org/10.1016/j.jncc.2025.01.003.
Mezquita L, Auclin E, Ferrara R, Charrier M, Remon J, Planchard D, et al. (2018). Association of the lung immune prognostic index with immune checkpoint inhibitor outcomes in patients with advanced non-small cell lung cancer. JAMA Oncol. 4(3):351–357. https://doi.org/10.1001/jamaoncol.2017.4771.
Miholjcic TBS, Halse H, Bonvalet M, Bigorgne A, Rouanne M, Dercle L, et al. (2023). Rationale for LDH-targeted cancer immunotherapy. Eur J Cancer. 181:166–178. https://doi.org/10.1016/j.ejca.2022.11.032.
Mishra D, Banerjee D (2019). Lactate dehydrogenases as metabolic links between tumor and stroma in the tumor microenvironment. Cancers. 11(6):750. https://doi.org/10.3390/cancers11060750.
Park Y, Chung C (2024). Immune evasion of G-CSF and GM-CSF in lung cancer. Tuberc Respir Dis. 87(1): 22–30. https://doi.org/10.4046/trd.2023.0037.
Rami-Porta R, Nishimura KK, Giroux DJ, Detterbeck F, Cardillo G, Edwards JG, et al. (2024). The International Association for the Study of Lung Cancer Lung Cancer Staging Project: proposals for revision of the TNM stage groups in the forthcoming ninth edition of the TNM classification for lung cancer. J Thorac Oncol. 19(7):1007–1027. https://doi.org/10.1016/j.jtho.2024.02.011.
Riudavets M, Auclin E, Mosteiro M, Dempsey N, Majem M, Prelaj A, et al. (2024). Association between lung immune prognostic index and durvalumab consolidation outcomes in patients with locally advanced non-small cell lung cancer. Clin Lung Cancer. 25(3): 233–243.e8. https://doi.org/10.1016/j.cllc.2023.11.007.
Wang Y, Lei Y, Zheng D, Yang Y, Luo L, Li J, et al. (2024). Prognostic value of lung immune prognostic index in non-small cell lung cancer patients receiving immune checkpoint inhibitors: a meta-analysis. Pathol Oncol Res. 30:1–13. https://doi.org/10.3389/pore.2024.1611773.
Wang Y, Safi M, Hirsch FR, Lu S, Peters S, Govindan R, et al. (2025). Immunotherapy for advanced-stage squamous cell lung cancer: the state of the art and outstanding questions. Nat Rev Clin Oncol. 22(3):200–214. https://doi.org/10.1038/s41571-024-00979-8.
Xiong A, Xu J, Wang S, Zhong R (2023). On-treatment lung immune prognostic index is predictive for first-line PD-1 inhibitor combined with chemotherapy in patients with non-small cell lung cancer. Front Immunol. (5):1–10. https://doi.org/10.3389/fimmu.2023.1173025.
Xue H, Fan Y, Li Y, Zhao Q, Zhang X, Zhao P, et al. (2025). Tumor-infiltrating lymphocytes in NSCLC: from immune surveillance to immunotherapy. Front Immunol. 16:1–9. https://doi.org/10.3389/fimmu.2025.1610998.
Yang T, Hao L, Yang X, Luo C, Wang G, Cai CL, et al. (2021). Prognostic value of derived neutrophil-to-lymphocyte ratio in patients with non-small cell lung cancer receiving immune checkpoint inhibitors: a meta-analysis. BMJ Open. 11:e049123. https://doi.org/10.1136/bmjopen-2021-049123.
Zhi X, Zhang Z, Li W, Dong Z, Wu X, Ge X, et al. (2024). Correlation of lung immune prognostic index with the efficacy of immune checkpoint inhibitors in Chinese patients with advanced non-small cell lung cancer. Holistic Integrative Oncology. 3: 2. https://doi.org/10.1007/s44178-023-00067-4.
Zhou J, Xu Y, Liu J, Feng L, Yu J, Chen D (2024). Global burden of lung cancer in 2022 and projections to 2050: incidence and mortality estimates from GLOBOCAN. Cancer Epidemiol. 93: 102693. https://doi.org/10.1016/j.canep.2024.102693.
