Lung Immune Prognostic Index: A Tool for Stratifying Survival in Stage III NSCLC

Lung Immune Prognostic Index (LIPI) measured at diagnosis stratifies prognosis in stage III non‑small cell lung cancer, identifying a clear gradient of event‑free and overall survival across prognostic categories.

LIPI combines two routinely available laboratory parameters—the derived neutrophil‑to‑lymphocyte ratio (dNLR) and lactate dehydrogenase (LDH)—that together reflect systemic inflammation and tumor metabolic activity. A high dNLR suggests impaired lymphocyte‑mediated tumor control; elevated LDH points to hypoxia and aggressive tumor metabolism. Compact and reproducible from baseline labs, LIPI offers a practical index to sharpen risk estimates in multimodal stage III care.

In a retrospective analysis of a 68‑patient stage III NSCLC cohort, investigators evaluated event‑free survival (EFS) and overall survival (OS) and found LIPI independently associated with shorter EFS and OS after multivariable adjustment. Median EFS clustered by LIPI category at about 17.7, 9.4, and 5.8 months for good, intermediate, and poor groups, respectively; median OS was 25.7 months for the good group versus 6.7 months for the poor group. Multivariate hazard ratios for poor LIPI were roughly 2.6–2.9 for progression and death, indicating substantially higher progression and mortality risk with worse scores.

Operationally, LIPI’s benefits are immediate: it is inexpensive, reproducible across laboratories, and calculable from routine CBC and LDH measurements, facilitating incorporation into baseline assessment workflows. LIPI can help contextualize surveillance intensity, flag candidates for closer follow‑up or trial referral, and inform multidisciplinary discussions about escalation of multimodal therapy—without prescribing specific treatment changes. However, the underlying evidence is limited by a single‑cohort, retrospective design, modest sample size (n = 68), heterogeneity in real‑world treatments, and the absence of contemporary consolidation immunotherapy in the studied population; prospective validation and integration with other biomarkers are therefore required.