ArticleInternational journal of urology : official journal of the Japanese Urological Association2026
Prognostic Value of the Lung Immune Prognostic Index in Metastatic Renal Cell Carcinoma Treated With Second-Line Immunotherapy.
Article in International journal of urology : official journal of the Japanese Urological Association, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesPrognostic stratification remains challenging in patients with metastatic renal cell carcinoma (mRCC) treated with immune checkpoint inhibitors. The Lung Immune Prognostic Index (LIPI) may better reflect immunotherapy-related outcomes in this setting.
methodsThis retrospective study included 120 patients with mRCC who received second-line nivolumab after progression on prior tyrosine kinase inhibitor therapy. LIPI was calculated using lactate dehydrogenase (LDH) and derived neutrophil-to-lymphocyte ratio (dNLR), and patients were categorized into good, intermediate, and poor risk groups. Overall survival (OS) was estimated using the Kaplan-Meier method and compared with the log-rank test. Prognostic performance was assessed using log-rank Chi-squared statistics and the concordance index (C-index). Cox regression analyses were performed to identify independent prognostic factors for OS.
resultsKaplan-Meier analyses demonstrated the most distinct survival separation for LIPI compared with MSKCC and IMDC risk models. Log-rank Chi-squared values were approximately 24 for LIPI, 16 for MSKCC, and 6.6 for IMDC. Concordance analysis confirmed superior prognostic discrimination with LIPI (C-index 0.639) compared with MSKCC (0.618) and IMDC (0.555). In multivariate analysis, ECOG performance status 2 (HR 4.18, 95% CI 1.62-10.79; p = 0.003), absence of diabetes mellitus (HR 0.45, 95% CI 0.25-0.79; p = 0.005), absence of prior nephrectomy (HR 1.93, 95% CI 1.10-3.37; p = 0.021), and absence of brain metastases (HR 0.47, 95% CI 0.23-0.95; p = 0.036) were independently associated with OS.
conclusionsIn mRCC patients treated with second-line nivolumab, LIPI provided superior discrimination for OS compared with established risk models, supporting its clinical utility.
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