To investigate the predictive utility of the lung immune prognostic index (LIPI) in a large Chinese cohort of patients following radical cystectomy for bladder cancer.

We conducted a retrospective data collection of patients diagnosed with bladder cancer who underwent radical cystectomy at West China Hospital from December 2010 to December 2020. Based on the LIPI scores determined using the derived neutrophil-to-lymphocyte ratio and lactate dehydrogenase levels, all patients were classified into either low-risk (0 points) or high-risk (1-2 points) categories. The association between LIPI and unfavorable pathological characteristics was evaluated using logistic regression analysis; the associations between LIPI and overall survival (OS) and between LIPI and recurrence-free survival (RFS) were evaluated using Kaplan‒Meier methods and Cox proportional hazard models. To lessen the bias of confounding factors, subgroup analysis was also carried out.

This research included a cohort of 527 individuals who received radical cystectomy. Multivariate logistic regression analysis revealed strong associations between LIPI and tumor diameter (OR: 2.477, 95% CI: 1.554-3.948, P < 0.001) and tumor number (OR: 2.078, 95% CI: 1.294-3.338, P = 0.002). Kaplan-Meier curve revealed that patients in the high-risk LIPI subgroup had significantly inferior OS (P < 0.001) and RFS (P = 0.003) than did those in the low-risk subgroup. Univariate Cox proportional hazards regression showed that high-risk LIPI was a poor prognostic factor for OS (hazard ratio (HR) 1.904, 95% CI: 1.398- 2.593) and RFS (HR 1.656, 95% CI: 1.192- 2.301). After adjusting for clinical features, multivariate analysis revealed that high-risk LIPI was an independent risk factor for OS (HR 1.539, 95% CI: 1.111- 2.133) but not for RFS.

Preoperative LIPI, an independent prognostic biomarker that is dependable, readily available, and novel, has the potential to predict survival in bladder cancer patients undergoing radical cystectomy.