Association of the Pretreatment Lung Immune Prognostic Index with Immune Checkpoint Inhibitor Outcomes in Patients with Advanced Hepatocellular carcinoma

Abstract Objective To evaluate whether the pretreatment Lung Immune Prognostic Index (LIPI) is associated with outcomes in advanced hepatocellular carcinoma (HCC) patients under ICI. Methods A two-center retrospective study of patients with HCC treated with immune checkpoint inhibitors (ICIs) between January 2018 and January 2021 was performed. The patients were stratified into three groups (good LIPI, intermediate LIPI, and poor LIPI) according to pretreatment LIPI based on dNLR (neutrophil count/ [white blood cell count - neutrophil count]) greater than 3 and LDH greater than LDH normal value. The primary endpoints were overall survival (OS) and progression-free survival (PFS). The second endpoints were disease control rate (DCR) and objective response rate (ORR). Results In the pooled cohort (n=224), 80 (35.7%) had a good LIPI (zero factor), 91 (40.6%) had intermediate LIPI (one factor), and 53 (23.7%) had poor LIPI (two factors). The median follow-up was 25.1 months. Median OS was 16.8 months, 12.5 months, and 9.5 months for the good, intermediate, and poor LIPI groups, respectively (P < 0.0001). Median PFS was 11.8 months, 7.8 months, and 4.0 months for the good, intermediate, and poor LIPI groups, respectively ( P <0.0001) The intermediate LIPI and poor LIPI were independently associated with shorter OS, PFS，and lower ORR, DCR ( P ＜0.05). Conclusion Pretreatment LIPI was correlated with worse outcomes for ICIs suggesting that LIPI could be promising biomarker for advanced HCC patients under ICIs.