Abstract
Background: The Naples prognostic score (NPS) is established according to nutritional or inflammatory state, which has been identified as a new prognostic score for various malignant tumors. However, its prognosis prediction effect on gastric cancer (GC) patients is still unknown so far. The present work aimed to examine the NPS function in the prediction of GC prognosis.Methods: In this study, patients undergoing surgery with no preoperative therapy were retrospectively examined from June 2011 to August 2019. Typically, the total cholesterol level, serum albumin content, neutrophil-to-lymphocyte ratio and lymphocyte-to-monocyte ratio were determined to calculate the NPS. Besides, the prognostic value of NPS was evaluated by survival analyses. Time-dependent receiver operating characteristic (t-ROC) curve analysis was also carried out to compare the prognostic value of the scoring systems.Results: Altogether 1,283 cases were enrolled into the present work. NPS was markedly related to age, gender, tumor size, body mass index, vascular invasion, perineural invasion, and pTNM stage. Upon multivariate analysis, NPS was identified as an independent prognostic factor for the prediction of overall survival (OS) (P < 0.001). In subgroup analyses stratified by adjuvant chemotherapy or surgery alone, NPS was still the independent prognostic factor for OS in both groups (both P < 0.001). Furthermore, NPS exhibited higher accuracy in the prediction of OS than additional prognostic factors, as revealed by the results of t-ROC curve analysis.Conclusions: NPS is a simple and useful scoring system that can be used to independently predict the survival of GC cases undergoing surgery.
Highlights
Gastric cancer (GC) ranks the 5th place in terms of its morbidity, which affects 1,033,701 people annually; it ranks the 3rd place among the causes of cancer-related deaths, with around 782,685 GC-related death cases being reported annually [1]
An increasing number of studies report that Naples prognostic score (NPS), which is established based on the preoperative total cholesterol (TC) content, serum albumin (Alb) content, lymphocyte-to-monocyte ratio (LMR) and neutrophil-tolymphocyte ratio (NLR), represents a new inflammation-related prognostic scoring system
An example is the clinical significance of tumor-infiltrating lymphocytes (TILs), which are related to the superior prognosis for various cancer types, and this may be related to the anticancer effects induced by TILs and the suppression of angiogenesis [15, 16]
Summary
Gastric cancer (GC) ranks the 5th place in terms of its morbidity, which affects 1,033,701 people annually; it ranks the 3rd place among the causes of cancer-related deaths, with around 782,685 GC-related death cases being reported annually [1]. Since Virchow first systematically reported the relationship of inflammation with cancer in the 19th century, more and more studies suggest the vital role of systemic inflammation in the tumor microenvironment (TME) [2, 3]. An increasing number of studies report that NPS, which is established based on the preoperative total cholesterol (TC) content, serum albumin (Alb) content, LMR and NLR, represents a new inflammation-related prognostic scoring system. NPS is more accurate than other prognostic factors in predicting survival [9, 10, 12] It takes into account the effects of systemic inflammation and nutritional status on cancer prognosis. The present work aimed to examine the NPS function in the prediction of GC prognosis
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