Prognostic Value of the Lung Immune Prognostic Index on Recurrence after Radical Surgery for High-Risk Renal Cell Carcinoma

Simple Summary Further risk stratification among high-risk renal cell carcinomas is relevant as it helps balance the benefits and drawbacks of adjuvant immunotherapy. The effects of the lung immune prognostic index (LIPI), which is calculated based on the derived neutrophil-to-lymphocyte ratio and lactate dehydrogenase levels, and was evaluated using a retrospective, multi-institutional database. Of the 235 patients with high-risk renal cell carcinoma (>= pT3 or N1-2 and M0), 119 (50.6%), 91 (38.7%), and 25 (10.6%) were categorized as good (0), intermediate (1), and poor (2) based on the LIPI score, respectively, and recurrence-free survival (RFS) was significantly correlated with the score groups (median progression-free survival: 90.8 vs. 21.2 vs. 10.0 months). The LIPI was an independent predictor of RFS, and prediction accuracy improved with the addition of the LIPI to preexisting scores. The LIPI can be a useful biomarker for predicting recurrence, particularly for identifying the highest-risk cohorts.Abstract 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.