Composite clinical scores in real-world extensive-stage small-cell lung cancer patients treated with chemo-immunotherapy

BACKGROUND: Composite scores such as Lung Immune Prognostic Index (LIPI), modified Glasgow Prognostic Score (mGPS), EPSILoN, Pan Immune-Inflammation Value (PIV) and Systemic Immune-Inflammation Index (SII) have shown prognostic value in solid tumors, but evidence in extensive-stage small-cell lung cancer (ES-SCLC) are limited. METHODS: This monocentric retrospective/prospective observational study included 67 ES-SCLC patients treated with first-line chemo-immunotherapy. Baseline clinical and laboratory data were collected. LIPI, mGPS, and EPSILoN were calculated according to previously reported methodology; optimal cut-offs for SII and PIV were determined using maximally selected rank statistics. Survival outcomes were estimated through Kaplan-Meier method. Prognostic associations were evaluated through univariate and multivariate Cox proportional hazards models. RESULTS: Median progression free survival (PFS) and overall survival (OS) in the study cohort were 4.8 and 11.3 months; 14.9% achieved long term survival (OS 24 months). Poor-risk categories of LIPI (PFS p<0.0001, OS p<0.0001), EPSILoN (PFS p=0.0012, OS p=0.0301), PIV (PFS p=0.0147, OS p=0.00543), and SII (PFS p=0.00016, OS p<0.0001) were strongly associated with inferior outcomes. In multivariate analysis, LIPI, EPSILoN and SII independently predicted both PFS and OS, whereas PIV retained significance for OS only. mGPS did not emerge as an independent prognostic marker. CONCLUSIONS: LIPI, SII and EPSILoN demonstrated significant prognostic value in ES-SCLC patients receiving first line chemo-immunotherapy, supporting their role in clinical stratification.