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Clinical Studies

The lung immune prognostic index stratifies the occurrence of checkpoint inhibitor pneumonitis in advanced non-small cell lung cancer patients: a multi-institutional cohort study

British Journal of Cancer (2025)Cite this article

Subjects

Abstract

Background

Lung immune prognostic index (LIPI) is associated with survival outcomes in patients with non-small cell lung cancer (NSCLC) receiving immunotherapy, but the association with the occurrence of checkpoint inhibitor pneumonitis (CIP) is unclear.

Methods

We retrospectively included 1824 patients with advanced NSCLC who received immune checkpoint inhibitors (ICIs) at two institutions. Cox regression analysis and cumulative incidence curve were used to evaluate the predictive value of LIPI. Additionally, we performed competing risk analysis using Fine-Gray regression and cumulative incidence curves.

Results

During a median follow-up of 15 months, 99 patients developed CIP. Compared with the good LIPI group, the intermediate LIPI group (HR 1.87, P = 0.007) and poor LIPI group (HR 4.39, P < 0.001) had a higher risk of CIP. Furthermore, we found LIPI was an independent predictor for intermediate-grade CIP (intermediate LIPI: HR 2.11, P = 0.056; poor LIPI: HR 4.51, P = 0.002) and high-grade CIP (intermediate LIPI: HR 6.94, P = 0.014; poor LIPI: HR 44.01, P < 0.001), but not for low-grade CIP (intermediate LIPI: HR 1.31, P = 0.392; poor LIPI: HR 0.72, P = 0.656). Similar results were obtained after competing risk analysis.

Conclusions

LIPI grade shows potential in predicting the risk of CIP during immunotherapy and could be valuable in clinical management.

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Fig. 1: Patient recruitment flow chart.
Fig. 2: Representative axial CT images show different grades of CIP in patients after ICI treatment.
Fig. 3: Heat map shows the relationship between LIPI, clinical features and CIP.
Fig. 4: Cumulative incidence curves of CIP.
Fig. 5: Cumulative incidence curves considering death as a competing risk event.

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Data availability

The datasets used and/or analyzed during the current study available from the corresponding author on reasonable request.

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Funding

This study was supported by grants from the Major Program of Special Project for Technology Innovation of Hubei Province (2023BCB014), the National Natural Science Foundation of China (82172034, 82272083, 82472058) and the Fundamental Research Funds for the Central Universities (20242422).

Author information

Author notes

  1. These authors contributed equally: Bingxin Gong, Yusheng Guo, Qi Wan

Authors and Affiliations

  1. Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

    Bingxin Gong, Yusheng Guo, Jie Lou, Yi Li, Feng Pan & Lian Yang

  2. Hubei Provincial Clinical Research Center for Precision Radiology & Interventional Medicine, Wuhan, China

    Bingxin Gong, Yusheng Guo, Jie Lou, Yi Li, Feng Pan & Lian Yang

  3. Hubei Key Laboratory of Molecular Imaging, Wuhan, China

    Bingxin Gong, Yusheng Guo, Jie Lou, Yi Li, Feng Pan & Lian Yang

  4. Department of Radiology, the Key Laboratory of Advanced Interdisciplinary Studies Center, National Center for Respiratory Medicine, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China

    Qi Wan

  5. College of Medical Technology and Engineering, Henan University of Science and Technology, Luoyang, China

    Guisheng Zhang

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Contributions

Bingxin Gong and Yusheng Guo drafted the manuscript; Qi Wan and Yi Li revised the manuscript; Bingxin Gong and Jie Lou performed data analysis and interpretation; Guisheng Zhang and Qi Wan collected the data; Lingli Li and Lian Yang made substantial contributions to the conception and design of the work. All authors involved in manuscript writing and final approval of the manuscript.

Corresponding authors

Correspondence to Feng Pan or Lian Yang.

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The authors declare no competing interests.

Ethics approval and consent to participate

All methods were performed in accordance with the relevant guidelines and regulations. This study was approved by the Ethics Committee of Tongji Medical College, Huazhong University of Science and Technology (No. S048) and The First Affiliated Hospital of Guangzhou Medical University (ES-2024-K173-01), and informed consent was obtained from all participants. Written informed consent for publication of the images has been obtained from the authors.

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Gong, B., Guo, Y., Wan, Q. et al. The lung immune prognostic index stratifies the occurrence of checkpoint inhibitor pneumonitis in advanced non-small cell lung cancer patients: a multi-institutional cohort study. Br J Cancer (2025). https://doi.org/10.1038/s41416-025-03124-z

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