With emerging options in immediate postoperative settings for high-risk renal cell carcinoma (hrRCC), further risk stratification may be relevant for informed decision making. Balancing the benefits and drawbacks of adjuvant immunotherapy is recommended. We aimed to evaluate the effects of the lung immune prognostic index (LIPI) in this setting. This bi-institutional retrospective study recruited 235 patients who underwent radical surgery for hrRCC between 2004 and 2021. LIPI scores were calculated based on the derived neutrophil-to-lymphocyte ratio and lactate dehydrogenase levels. The association between LIPI scores and local or distant recurrence was analyzed, along with other possible clinical factors. The median recurrence-free survival (RFS) period was 36.4 months. Based on the LIPI scores, 119, 91, and 25 patients were allocated to the good, intermediate, and poor groups, respectively. The RFS was significantly correlated with the LIPI scores, and the 36 month survival rates were 67.3, 36.2, and 11.0% in the good, intermediate, and poor groups, respectively. In the multivariate model, the LIPI independently predicted the RFS, along with symptoms at diagnosis, Eastern Cooperative Oncology Group performance status, pT status, pN status, and tumor grade. The C-index of the LIPI in predicting RFS was 0.63, and prediction accuracy improved with the addition of the LIPI to both GRade, Age, Nodes, Tumor, and the UCLA Integrated Staging System. Conclusively, the LIPI can be a significant prognostic biomarker for predicting hrRCC recurrence, particularly for identifying the highest-risk cohort.
随着高危肾细胞癌术后即刻治疗方案的不断涌现，进一步的风险分层对临床决策具有重要意义。目前建议在辅助免疫治疗中权衡获益与风险。本研究旨在评估肺免疫预后指数在此背景下的应用价值。这项双中心回顾性研究纳入了2004年至2021年间接受根治性手术的235例高危肾细胞癌患者。根据衍生中性粒细胞-淋巴细胞比值和乳酸脱氢酶水平计算肺免疫预后指数评分。分析该评分与局部或远处复发的关系，并探讨其他临床因素的影响。中位无复发生存期为36.4个月。根据肺免疫预后指数评分，患者被分为良好组（119例）、中等组（91例）和不良组（25例）。无复发生存期与肺免疫预后指数评分显著相关，三组患者的36个月生存率分别为67.3%、36.2%和11.0%。在多变量模型中，肺免疫预后指数与诊断时症状、东部肿瘤协作组体能状态、病理T分期、病理N分期及肿瘤分级共同成为无复发生存期的独立预测因素。肺免疫预后指数预测无复发生存期的C指数为0.63，将其纳入GRade分级、年龄、淋巴结、肿瘤和UCLA综合分期系统后，预测准确性均得到提升。结论：肺免疫预后指数可作为预测高危肾细胞癌复发的重要预后生物标志物，特别适用于识别最高风险患者群体。
肿瘤(癌症)患者之家