Exploring the prognostic value of the magnesium-immune prognostic score (MIPS) in metastatic non-small cell lung cancer receiving Nivolumab.

BACKGROUND

Although immune checkpoint inhibitors have transformed the treatment landscape in advanced non-small cell lung cancer (NSCLC), reliable and accessible biomarkers to predict survival and treatment response remain limited. This study aimed to evaluate the prognostic and predictive utility of the Magnesium-Immune Prognostic Score (MIPS), a composite index based on neutrophil-to-lymphocyte ratio and serum levels of C-reactive protein, magnesium, albumin, calcium, phosphorus, lactate dehydrogenase, and uric acid, in metastatic NSCLC patients receiving second-line nivolumab.

METHODS

This retrospective study included 95 patients with advanced NSCLC treated with nivolumab. The MIPS was constructed by integrating three predefined component indices: the Inflammation-Mediated Immunity Index (IMI), the Mineral and Nutritional Index (MINI), and the Aggressive Tumor Index (ATI). Survival outcomes were analyzed using ROC curves, Kaplan-Meier methods, and Cox regression models.

RESULTS

Among 95 patients, those with high MIPS had significantly shorter progression-free survival and overall survival than those with low MIPS (p < 0.001). In multivariable Cox analysis, high MIPS remained an independent predictor of poor OS (HR: 2.694, p < 0.001). Among all indices, MIPS showed the strongest discriminative ability (AUC = 0.696). All four composite indices-IMI, MINI, ATI, and MIPS-were significantly associated with treatment response, with high-score groups demonstrating higher rates of good response (CR + PR), and MIPS showing the strongest association (p < 0.001).

CONCLUSION

The MIPS represents a simple, accessible, and clinically applicable prognostic and predictive tool for stratifying metastatic NSCLC patients receiving nivolumab. By integrating inflammatory, nutritional, and metabolic components, the score offers a holistic assessment of patient biology. Prospective validation studies are warranted.