The lung immune prognostic index as a predictive biomarker in urological malignancies undergoing immune checkpoint inhibitor therapy

We conducted a meta-analysis to evaluate the prognostic utility of the Lung Immune Prognostic Index (LIPI) in patients with urological malignancies treated with immune checkpoint inhibitors (ICIs). We systematically searched PubMed, the Cochrane Library, and EMBASE up to March 3, 2025. Clinical outcomes included overall survival (OS), progression-free survival (PFS), objective response rate (ORR), and disease control rate (DCR). Study quality was assessed using the Newcastle-Ottawa Scale (NOS), with a threshold score ≥6 defining high-quality studies. This meta-analysis incorporated seven studies comprising 2498 patients. Our findings demonstrated that patients with good LIPI index exhibited significantly prolonged OS (good vs. intermediate: HR = 0.51, 95% CI 0.42–0.62, <i>p</i> &lt; 0.001; good vs. poor: HR = 0.15, 95% CI 0.11–0.20, <i>p</i> &lt; 0.001; good vs. Intermediate and poor: HR = 0.48, 95% CI 0.38–0.61, <i>p</i> &lt; 0.001). The data further showed that patients with good LIPI index exhibited significantly prolonged PFS; (good vs. intermediate: HR = 0.66, 95% CI 0.57–0.76, <i>p</i> &lt; 0.001; good vs. poor: HR = 0.23, 95% CI 0.14–0.37, <i>p</i> &lt; 0.001; good vs. Intermediate and poor: HR = 0.73, 95% CI 0.66–0.81, <i>p</i> &lt; 0.001). Additionally, we found that the good LIPI index correlated with higher ORR (good vs. intermediate: OR = 1.50, 95% CI: 0.98–2.28, <i>p</i> = 0.061; good vs. poor: OR = 1.96, 95% CI: 1.01–3.83, <i>p</i> = 0.047). The good LIPI index correlated with higher DCR (good vs. intermediate: OR = 2.15, 95% CI: 1.53–3.01, <i>p</i> &lt; 0.001; good vs. poor: OR = 5.08, 95% CI: 2.85–9.05, <i>p</i> &lt; 0.001). No publication bias existed, and sensitivity analysis confirmed stable results. The LIPI emerges as a valuable prognostic biomarker in patients with urological malignancies treated with ICIs therapy.