{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T05:07:33Z","timestamp":1788930453034,"version":"build-2803163510"},"reference-count":30,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T00:00:00Z","timestamp":1788480000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: Clinical outcomes with immune checkpoint inhibitors (ICIs), such as nivolumab, vary among patients with metastatic non-small cell lung cancer (NSCLC). The Lung Immune Prognostic Index (LIPI) may help stratify prognosis. This study evaluated the prognostic significance of LIPI in patients receiving second- or third-line nivolumab and developed a nomogram for individualized survival estimation. Methods: This single-center retrospective study included 142 patients with metastatic NSCLC who received second- or third-line nivolumab between February 2022 and December 2024, after progression on platinum-based chemotherapy. LIPI was calculated from baseline values obtained within 14 days before nivolumab initiation, based on a derived neutrophil-to-lymphocyte ratio (dNLR) &gt; 3 and lactate dehydrogenase (LDH) &gt; 225 U\/L (institutional upper limit of normal), classifying patients as good-, intermediate-, or poor-risk (0, 1, or 2 factors, respectively). Overall survival (OS) and progression-free survival (PFS) were estimated by the Kaplan\u2013Meier method; independent prognostic factors were assessed by multivariable Cox regression, and a prognostic nomogram combining ECOG performance status, serum albumin, and LIPI was developed and internally validated. Results: By LIPI, 34.5%, 45.1%, and 20.4% of patients were at good, intermediate, and poor risk, respectively. Objective response and disease control rates were 29.6% and 55.6%. Median OS and PFS were 19.3\/8.0\/3.1 and 8.6\/3.1\/2.5 months across good, intermediate, and poor LIPI groups (log-rank p &lt; 0.001). In multivariable analysis, ECOG 2 (hazard ratio [HR], 4.94), albumin per 1 g\/dL (HR 0.27), and poor versus good LIPI (HR 3.74) were independently associated with OS. A nomogram combining these three factors showed acceptable discrimination (optimism-corrected Harrell C-statistic 0.742). Conclusions: LIPI was independently associated with prognosis in this cohort. Combining LIPI with ECOG and albumin may aid individualized risk assessment, pending external validation.<\/jats:p>","DOI":"10.3390\/jcm15176869","type":"journal-article","created":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T17:25:56Z","timestamp":1788542756000},"page":"6869","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prognostic Value of the Lung Immune Prognostic Index and an ECOG\u2013Albumin\u2013LIPI Nomogram in Metastatic NSCLC Patients Treated with Second- or Third-Line Nivolumab"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9956-3900","authenticated-orcid":false,"given":"Didem","family":"Divriklio\u011flu","sequence":"first","affiliation":[{"name":"Department of Medical Oncology, Edirne Sultan 1. Murat State Hospital, 22030 Edirne, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u0130smail","family":"Bayrak\u00e7\u0131","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Nev\u015fehir State Hospital, 50300 Nev\u015fehir, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gizem","family":"Bak\u0131r Kahveci","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Faculty of Medicine, Trakya University, 22030 Edirne, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0382-5396","authenticated-orcid":false,"given":"\u0130vo","family":"G\u00f6kmen","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Faculty of Medicine, \u00c7anakkale Onsekiz Mart University, 17100 \u00c7anakkale, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2573-6634","authenticated-orcid":false,"given":"Dicle Yurdatap","family":"Ko\u00e7","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Faculty of Medicine, Trakya University, 22030 Edirne, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4055-9402","authenticated-orcid":false,"given":"Ece","family":"Demirdelen","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Faculty of Medicine, Trakya University, 22030 Edirne, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7399-2360","authenticated-orcid":false,"given":"Ahmet","family":"K\u00fc\u00e7\u00fckarda","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Faculty of Medicine, Trakya University, 22030 Edirne, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8490-3239","authenticated-orcid":false,"given":"Muhammet Bekir","family":"Hac\u0131o\u011flu","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Faculty of Medicine, Trakya University, 22030 Edirne, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B\u00fclent","family":"Erdo\u011fan","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Faculty of Medicine, Trakya University, 22030 Edirne, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5387-8309","authenticated-orcid":false,"given":"Sernaz","family":"Topalo\u011flu","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Faculty of Medicine, Trakya University, 22030 Edirne, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"723","DOI":"10.1200\/JCO.20.01605","article-title":"Five-Year Outcomes From the Randomized, Phase III Trials CheckMate 017 and 057: Nivolumab Versus Docetaxel in Previously Treated Non-Small-Cell Lung Cancer","volume":"39","author":"Borghaei","year":"2021","journal-title":"J. Clin. Oncol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1186\/s12935-025-03800-3","article-title":"A novel model for predicting immunotherapy response and prognosis in NSCLC patients","volume":"25","author":"Zang","year":"2025","journal-title":"Cancer Cell Int."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"741","DOI":"10.2147\/CMAR.S461964","article-title":"The Construction of a Nomogram Using the Pan-Immune-Inflammation Value Combined with a PILE Score for Immunotherapy Prediction Prognosis in Advanced NSCLC","volume":"16","author":"Ma","year":"2024","journal-title":"Cancer Manag. Res."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e22964","DOI":"10.1002\/jcla.22964","article-title":"Systemic immune-inflammation index, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio can predict clinical outcomes in patients with metastatic non-small-cell lung cancer treated with nivolumab","volume":"33","author":"Liu","year":"2019","journal-title":"J. Clin. Lab. Anal."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Platini, H., Ferdinand, E., Kohar, K., Prayogo, S.A., Amirah, S., Komariah, M., and Maulana, S. (2022). Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio as Prognostic Markers for Advanced Non-Small-Cell Lung Cancer Treated with Immunotherapy: A Systematic Review and Meta-Analysis. Medicina, 58.","DOI":"10.3390\/medicina58081069"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1001\/jamaoncol.2017.4771","article-title":"Association of the Lung Immune Prognostic Index With Immune Checkpoint Inhibitor Outcomes in Patients With Advanced Non-Small Cell Lung Cancer","volume":"4","author":"Mezquita","year":"2018","journal-title":"JAMA Oncol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"22062","DOI":"10.1002\/cam4.6805","article-title":"The relationship between clinicopathological variables, systemic inflammation, and CT-derived body composition with survival in patients with advanced non-small cell lung cancer receiving nivolumab as a second-line treatment","volume":"12","author":"Saeed","year":"2023","journal-title":"Cancer Med."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Wang, Y., Lei, Y., Zheng, D., Yang, Y., Luo, L., Li, J., and Xie, X. (2024). Prognostic value of lung immune prognostic index in non-small cell lung cancer patients receiving immune checkpoint inhibitors: A meta-analysis. Pathol. Oncol. Res., 30.","DOI":"10.3389\/pore.2024.1611773"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"223","DOI":"10.14740\/wjon1790","article-title":"Predictors of Immunotherapy Efficacy in Metastatic Non-Small Cell Lung Cancer: Lung Immune Prognostic Index and Immune-Related Toxicity","volume":"15","author":"Isla","year":"2024","journal-title":"World J. Oncol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"114048","DOI":"10.1016\/j.ejca.2024.114048","article-title":"Validation of the Lung Immune Prognostic Index (LIPI) as a prognostic biomarker in metastatic renal cell carcinoma","volume":"204","author":"Lavaud","year":"2024","journal-title":"Eur. J. Cancer"},{"key":"ref_11","first-page":"1484","article-title":"Lung immune prognostic index (LIPI) as a prognostic factor in patients with extensive-stage small cell lung cancer treated with first-line chemoimmunotherapy","volume":"27","year":"2025","journal-title":"Clin. Transl. Oncol."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Pierro, M., Baldini, C., Auclin, E., Vincent, H., Varga, A., Martin Romano, P., Vuagnat, P., Besse, B., Planchard, D., and Hollebecque, A. (2022). Predicting Immunotherapy Outcomes in Older Patients with Solid Tumors Using the LIPI Score. Cancers, 14.","DOI":"10.3390\/cancers14205078"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"7137357","DOI":"10.1155\/2022\/7137357","article-title":"Clinical Significance of Serum Biomarkers in Stage IV Non-Small-Cell Lung Cancer Treated with PD-1 Inhibitors: LIPI Score, NLR, dNLR, LMR, and PAB","volume":"2022","author":"Chen","year":"2022","journal-title":"Dis. Markers"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"6291","DOI":"10.1002\/cam4.4171","article-title":"Three models that predict the efficacy of immunotherapy in Chinese patients with advanced non-small cell lung cancer","volume":"10","author":"Zhao","year":"2021","journal-title":"Cancer Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1145","DOI":"10.1007\/s12325-020-01229-w","article-title":"Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR), and Outcomes with Nivolumab in Pretreated Non-Small Cell Lung Cancer (NSCLC): A Large Retrospective Multicenter Study","volume":"37","author":"Russo","year":"2020","journal-title":"Adv. Ther."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1089\/gtmb.2021.0006","article-title":"Clinical Significance and Prognostic Value of Lactate Dehydrogenase Expression in Cervical Cancer","volume":"26","author":"Ye","year":"2022","journal-title":"Genet. Test. Mol. Biomark."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/j.canlet.2020.12.020","article-title":"Metabolic adaptation in hypoxia and cancer","volume":"502","author":"Paredes","year":"2021","journal-title":"Cancer Lett."},{"key":"ref_18","first-page":"455","article-title":"Vascular endothelial growth factor (VEGF)\u2014Key factor in normal and pathological angiogenesis","volume":"59","author":"Melincovici","year":"2018","journal-title":"Rom. J. Morphol. Embryol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1016\/j.cllc.2021.12.010","article-title":"Serum Albumin: Early Prognostic Marker of Benefit for Immune Checkpoint Inhibitor Monotherapy But Not Chemoimmunotherapy","volume":"23","author":"Guo","year":"2022","journal-title":"Clin. Lung Cancer"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1006","DOI":"10.1111\/1759-7714.14349","article-title":"Association of lung immune prognostic index with survival outcome in advanced thymic carcinoma patients treated with palliative intent chemotherapy","volume":"13","author":"Araki","year":"2022","journal-title":"Thorac. Cancer"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1038\/s41416-022-01826-2","article-title":"Cancer cachexia: A nutritional or a systemic inflammatory syndrome?","volume":"127","author":"McGovern","year":"2022","journal-title":"Br. J. Cancer"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"17105","DOI":"10.1038\/nrdp.2017.105","article-title":"Cancer-associated cachexia","volume":"4","author":"Baracos","year":"2018","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1007\/s00262-026-04364-5","article-title":"Hypoalbuminemia induces immunosuppression through disorder in macrophages and drives resistance to immune checkpoint inhibitors","volume":"75","author":"Yang","year":"2026","journal-title":"Cancer Immunol. Immunother."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"14327","DOI":"10.1002\/cam4.6110","article-title":"Impact of the pretreatment prognostic nutritional index on the survival after first-line immunotherapy in non-small-cell lung cancer patients","volume":"12","author":"Oku","year":"2023","journal-title":"Cancer Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"100254","DOI":"10.1016\/j.esmoop.2021.100254","article-title":"Association of the advanced lung cancer inflammation index (ALI) with immune checkpoint inhibitor efficacy in patients with advanced non-small-cell lung cancer","volume":"6","author":"Mountzios","year":"2021","journal-title":"ESMO Open"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"3423","DOI":"10.21873\/invivo.12642","article-title":"Significance of Glasgow Prognostic Scores in NSCLC Patients Treated With Immunotherapy After Platinum-based Cytotoxic Chemotherapy","volume":"35","author":"Kang","year":"2021","journal-title":"In Vivo"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/j.lungcan.2020.04.027","article-title":"ECOG performance status \u22652 as a prognostic factor in patients with advanced non small cell lung cancer treated with immune checkpoint inhibitors-A systematic review and meta-analysis of real world data","volume":"145","author":"Maggio","year":"2020","journal-title":"Lung Cancer"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1016\/j.lungcan.2021.06.004","article-title":"Effectiveness and safety of immunotherapy in NSCLC patients with ECOG PS score \u22652\u2014Systematic review and meta-analysis","volume":"158","author":"Tomasik","year":"2021","journal-title":"Lung Cancer"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"26102","DOI":"10.1038\/s41598-024-76052-2","article-title":"Inflammatory factors are associated with prognosis of non-small cell lung cancer patients receiving immunotherapy: A meta-analysis","volume":"14","author":"Tong","year":"2024","journal-title":"Sci. Rep."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1016\/j.cllc.2021.03.006","article-title":"Biomarkers of Immune Checkpoint Inhibitors in Non-Small Cell Lung Cancer: Beyond PD-L1","volume":"22","year":"2021","journal-title":"Clin. Lung Cancer"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/17\/6869\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T04:21:56Z","timestamp":1788927716000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/17\/6869"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,4]]},"references-count":30,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["jcm15176869"],"URL":"https:\/\/doi.org\/10.3390\/jcm15176869","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,4]]}}}