The Lung Immune Prognostic Index May Predict the Efficacy of Different Treatments in Patients with Advanced NSCLC: A Meta-Analysis

Abstract

Background: Our purpose was to evaluate the predictive value of the lung immune prognostic index (LIPI) in patients with advanced non-small cell lung cancer (NSCLC) receiving different treatments. Methods: A systemic literature search of major databases of medicine was performed to explore the association of LIPI with different therapeutic effects in patients with advanced NSCLC, with overall survival (OS) as the surrogate marker. As such, HR and 95% CI were simultaneously selected to evaluate such an association. Results: A total of 4 studies involving 7,373 patients reported an association of the LIPI score with OS in advanced NSCLC patients. Further sorted by therapeutic regimen, the numbers of patients receiving immune checkpoint inhibitors (ICI), targeted therapy (TT), and chemotherapy (CT) were 3,651, 1,241, and 2,481, respectively. Overall, the good and intermediate LIPI groups (HR = 1.61; 95% CI 1.48–1.75; p < 0.01) showed no heterogeneity (I2 = 0%; p = 0.521), whereas the good and poor LIPI groups (HR = 2.74; 95% CI 2.26–3.33; p < 0.01) had a high heterogeneity (I2 = 67.9%; p = 0.019). For ICI, CT, and TT, the good and intermediate LIPI groups exhibited an HR of 1.70 (95% CI 1.49–1.93; p < 0.01) with I2 = 0% (p = 0.521), an HR 1.49 (95% CI 1.32–1.67; p < 0.01) with I2 = 0% (p = 0.437), and an HR of 1.85 (95% CI 1.45–2.36; p < 0.01) with I2 = 0% (p = 0.382), respectively. The good and poor LIPI groups had an HR of 3.46 (95% CI 2.72–4.39; p < 0.01) with I2 = 51.7% (p = 0.126), an HR of 2.22 (95% CI 1.85–2.66; p < 0.01) with I2 = 20.3% (p = 0.286), and an HR of 3.32 (95% CI 2.53–4.36; p < 0.01) with I2 = 0% (p = 0.703), for ICI, CT, and TT, respectively. Conclusions: In addition to being a possible prognostic indicator for advanced NSCLC patients receiving ICI, CT or TT, the LIPI may be used to stratify patients in randomized studies. These findings are of great help in deciding on the therapeutic strategy, and more well-designed studies are warranted to further verify them.

Evaluation of the Lung Immune Prognostic Index in Non-Small Cell Lung Cancer Patients Treated With Systemic Therapy: A Retrospective Study and Meta-Analysis

“…To our knowledge, only Xie et al. have published a meta-analysis about the relationship between the LIPI and efficacy of different treatments in NSCLC patients ( 38 ). In this article, there were only four studies included.…”

Systemic Inflammation/Nutritional Status Scores Are Prognostic but Not Predictive in Metastatic Non-Small-Cell Lung Cancer Treated with First-Line Immune Checkpoint Inhibitors

“…Another pooled analysis of 5 randomized trials evaluating ICIs versus CT only and 6 randomized trials evaluating targeted therapies (TTs) versus other TTs or CT only concluded also that the LIPI was prognostic in all the cohorts (1368 patients treated with ICIs and 1072 patients treated with CT only for the trials evaluating ICIs; 1110 patients treated with TTs and 437 patients treated with CT only for the trials evaluating TTs) [ 41 ]. A meta-analysis published a few years later finally concluded that the LIPI was prognostic, independent of the treatment [ 55 ].…”

Nivolumab or Atezolizumab in the Second-Line Treatment of Advanced Non-Small Cell Lung Cancer? A Prognostic Index Based on Data from Daily Practice

“…However, it should be noted that poor LIPI correlated with lower odds of achieving disease control (OR = 0.44; p = 0.005). An available meta-analysis of four clinical trials involving a total of 7373 patients with NSCLC receiving immunotherapy, targeted therapies, or chemotherapy demonstrated that LIPI groups can be effectively used to determine prognosis [ 31 ]. The LIPI groups predicted OS both in patients treated with immunotherapy and in those treated with targeted therapies or chemotherapy.…”