Novel Preoperative Immune Prognostic Index for Predicting Outcomes in Patients Undergoing Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma.

Abstract

Background/aim: The lung immune prognostic index (LIPI), which is determined by assessing the derived neutrophil-to-lymphocyte ratio in conjunction with the level of lactate dehydrogenase, predicts outcomes in various cancers. Its utility as a preoperative biomarker in upper tract urothelial carcinoma (UTUC) patients remains unexplored.

Patients and methods: This is a retrospective study of UTUC patients who underwent radical nephroureterectomy. Patients were stratified into favorable, intermediate, and poor LIPI groups. Non-urothelial tract recurrence-free survival (NUTRFS) was evaluated using Kaplan-Meier analysis, and Cox regression analyses were performed to identify risk factors for NUTRFS.

Results: A total of 567 UTUC patients were included, with 46.4% in the favorable, 44.6% in the intermediate, and 9.0% in the poor (9.0%) LIPI groups. The median participant age was 74 years, with a median follow-up of 26 months. Kaplan-Meier curves demonstrated that NUTRFS was significantly worse in patients with poor and intermediate LIPI scores than in those with favorable LIPI scores. Furthermore, combining LIPI status with pathological stages (pT3-4/ypT2-4) and lymph node metastasis status improved postoperative non-urothelial tract recurrence prognosis assessment.

Conclusion: The preoperative LIPI is a prognostic indicator for patients with UTUC undergoing nephroureterectomy. Its predictive accuracy improves when combined with advanced pathological stages and lymph node metastasis status.