Preoperative lung immune prognostic index (LIPI) predicts postoperative outcomes in clear cell renal cell carcinoma:...

Lactate dehydrogenase (LDH) and derived neutrophil-to-lymphocyte ratio (dNLR) are key prognostic factors for renal cancer. However, the association between the Lung Immune Prognostic Index (LIPI), based on dNLR and LDH, and renal cancer prognosis remains unclear. This study evaluates the prognostic value of LIPI for recurrence and survival in clear cell renal cell carcinoma (ccRCC) after nephrectomy. This retrospective study included 687 ccRCC patients who underwent radical or partial nephrectomy at three medical centers. Patients were stratified into good and intermediate/poor (int./poor) LIPI groups based on dNLR and LDH. Propensity score matching (PSM) was performed. Recurrence-free survival (RFS) and overall survival (OS) were analyzed using Kaplan-Meier curves and Cox models. Model discrimination was evaluated using C-indices, and subgroup and center-stratified analyses tested robustness. A total of 687 patients were included, with 491 classified into the good LIPI group and 196 into the int./poor group. After 1:1 PSM, each group comprised 196 patients. In the Kaplan-Meier survival analysis, the int./poor LIPI group exhibited significantly worse RFS and OS both before (RFS: P < 0.001; OS: P < 0.001) and after PSM (RFS: P < 0.001; OS: P < 0.001). In the multivariate Cox regression analysis post-PSM, int./poor LIPI remained independently associated with increased risk of recurrence (HR = 2.156, 95% CI: 1.349-3.449, P = 0.001) and mortality (HR = 3.238, 95% CI: 1.437-7.298, P = 0.005). Preoperative LIPI predicts ccRCC prognosis after nephrectomy. Patients in the good LIPI group exhibit significantly better RFS and OS.Trial registration: The study was registered at ClinicalTrials.gov (NCT06775574).