Abstract
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).
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Abbreviations
- ccRCC:
-
Clear cell renal cell carcinoma
- dNLR:
-
Derived neutrophil-to-lymphocyte ratio
- DFS:
-
Disease-free survival
- ECOG:
-
Eastern cooperative oncology group performance status
- EAU:
-
European association of urology
- eGFR:
-
Estimated glomerular filtration rate
- HRs:
-
Hazard ratios
- IRB:
-
Institutional review board
- IQR:
-
Interquartile range
- LDH:
-
Lactate dehydrogenase
- LIPI:
-
Lung Immune prognostic index
- NLR:
-
Neutrophil-to-lymphocyte ratio
- OS:
-
Overall survival
- PSM:
-
Propensity score matching
- RFS:
-
Recurrence-free survival
- RCC:
-
Renal cell carcinoma
- SMD:
-
Standardized mean difference
Acknowledgements
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Funding
This study was supported by grants from Startup Fund for scientific research of Fujian Medical University (2024QH1149), the National Natural Science Foundation of Fujian Province (No.2025J01829), the Joint Funds for the Innovation of Science and Technology of Fujian Province (No.2025Y9429), National Natural Science Foundation of China (82472058 and 82172034), and Noncommunicable Chronic Diseases-National Science and Technology Major Project (2024ZD0522802).
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The authors declare no competing interests.
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The ethical approvals for this study were provided by the Institutional Review Board of Wuhan Union Hospital, the Institutional Review Board of the Second Affiliated Hospital of Fujian Medical University, and the Institutional Review Board of Jiangsu Provincial People’s Hospital. The ethics committees of all three institutions independently reviewed the study protocol and granted waivers for informed consent due to its retrospective nature.
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This retrospective study utilized de-identified patient data, and the requirement for informed consent was waived by three institutional review boards.
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Pan, Z., Li, Y., Lou, J. et al. Preoperative lung immune prognostic index (LIPI) predicts postoperative outcomes in clear cell renal cell carcinoma: a multicenter study. Sci Rep (2026). https://doi.org/10.1038/s41598-026-54219-3
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DOI: https://doi.org/10.1038/s41598-026-54219-3
