Background: Immune checkpoint inhibitors (ICIs) have become a cornerstone in the treatment of advanced non-small cell lung cancer (NSCLC), yet substantial heterogeneity in clinical outcomes persists. Easily accessible biomarkers that can reliably stratify prognosis in real-world practice are still lacking. The Lung Immune Prognostic Index (LIPI), integrating lactate dehydrogenase (LDH) and the derived neutrophil-to-lymphocyte ratio (dNLR), has emerged as a promising candidate, yet its clinical relevance remains incompletely defined. Methods: We conducted a multicenter retrospective analysis of 211 patients with metastatic NSCLC treated with second-line nivolumab between 2017 and 2025. Patients were categorized into three groups (good, intermediate, and poor) according to their LIPI score, and the relationships between LIPI and objective response, disease control, progression-free survival (PFS), and overall survival (OS) were analyzed. Results: LIPI stratification effectively discriminated patients into prognostically distinct groups. Objective response rates were comparable across LIPI categories and did not differ significantly. In contrast, disease control declined progressively with worsening LIPI scores, reaching statistical significance (p < 0.001). Overall survival was significantly worse in patients with poor LIPI, demonstrating a clear stepwise reduction from good to poor LIPI groups (p = 0.007). Although progression-free survival showed a consistent numerical decrease across LIPI categories, this trend did not achieve statistical significance. Conclusions: In patients with metastatic NSCLC receiving second-line nivolumab in a real-world setting, LIPI reliably stratified overall survival and disease control outcomes, despite limited association with early response or progression-free survival. Its simplicity and reliance on routinely available laboratory parameters support its use as a clinically meaningful prognostic tool in everyday practice.
Bedir et al. (Sun,) studied this question.