Naples Prognostic Score Research Articles

Impact of Postoperative Naples Prognostic Score to Predict Survival in Patients with Stage II-III Colorectal Cancer.

The Naples prognostic score (NPS) is a scoring system that reflects a patient's systemic inflammatory and nutritional status. This study aimed to evaluate whether postoperative NPS is effective in assessing the prognosis of stage II-III colorectal cancer (CRC) patients compared with preoperative NPS. Between 2005 and 2012, a total of 164 patients diagnosed with stage II-III CRC, who underwent curative resection followed by adjuvant chemotherapy, were divided into two groups: Group 0-1 (NPS = 0-2) and Group 2 (NPS = 3 or 4). Preoperative NPS was calculated based on the results before surgeries, and postoperative NPS was assessed using the results obtained before adjuvant chemotherapy. The overall survival of Group 0-1 was higher than that of Group 2 in both pre- and postoperative NPS assessments. According to the ROC curve analysis, the Area Under the Curve (AUC) ratio for postoperative NPS was 0.64, compared with 0.57 for preoperative NPS, 0.52 for the preoperative neutrophil-lymphocyte ratio (p = 0.032), and 0.51 for the preoperative platelet-lymphocyte ratio (p = 0.027). Postoperative NPS is effective in predicting the prognosis of stage II-III CRC patients who underwent curative resection followed by adjuvant chemotherapy. The use of NPS could be beneficial in evaluating the prognosis of CRC patients after surgeries.

Naples Prognostic Score for Graft Functions After Renal Transplantation: A Retrospective Analysis.

BACKGROUND The Naples prognostic score is a comprehensive measure of patients' inflammation and nutritional status, consisting of serum albumin, total cholesterol, neutrophil/lymphocyte ratio (NLR), and lymphocyte/monocyte ratio (LMR). We compared the Naples prognostic scores of kidney transplant patients with a creatinine reduction ratio of less than 30% vs those with greater than 30%. MATERIAL AND METHODS We conducted a retrospective study on 93 patients who received kidney transplants at our hospital from January 2020 to January 2023. Naples prognostic scores were used to calculate the preoperative condition of transplant recipients. The patients were divided into 2 groups based on their creatinine reduction ratio on the second day after surgery. Group A consisted of patients with a ratio above 30%, while group B consisted of those with a ratio below 30%. RESULTS Our analysis revealed that the total cholesterol and albumin values of groups A and B showed no substantial difference. Group B had clearly more patients with Naples prognostic score 3-4 compared to the other group (P=0.032). Multivariate analysis determined that patients with Naples prognostic score 3-4 had a 3.151-fold higher likelihood of experiencing creatinine reduction below 30% (95% CI 1.209-8.215, P value 0.019). CONCLUSIONS The preoperative inflammatory and nutritional status of patients may have an impact on the functioning of grafts during the postoperative period. A high Naples prognostic score may be linked with a decrease in creatinine reduction ratio in post-transplant kidneys, which could lead to graft dysfunction.

Modified Naples prognostic score for evaluating the prognosis of patients with obstructive colorectal cancer

BackgroundInflammatory, immune, and nutritional status are key factors in obstructive colorectal cancer (OCRC). This study aims to investigate the value of modified Naples prognostic score (M-NPS) in evaluating OCRC prognosis.MethodsA total of 196 OCRC patients were retrospectively analyzed to construct M-NPS based on serum albumin (ALB), total cholesterol (CHOL), neutrophil:lymphocyte ratio (NLR), and lymphocyte:monocyte ratio (LMR), and then they were divided into three groups. The Kaplan–Meier (KM) method and Cox proportional hazard regression analysis were performed for overall survival (OS) and disease-free survival (DFS) of OCRC patients.ResultsPatients with high M-NPS had worse OS and DFS (P = 0.0001, P = 0.0011). Multivariate COX analysis showed that M-NPS was an independent prognostic factor for OCRC patients. Patients in the M-NPS 2 group had significantly worse OS (hazard ratio [HR] = 4.930 (95% confidence interval [95% CI], 2.217–10.964), P < 0.001) and DFS (HR = 3.508 (95% CI, 1.691–7.277), P < 0.001) than those in the 0 group.ConclusionM-NPS was an independent prognostic factor for OCRC patients; it might provide a potential reference for immunonutritional intervention in patients with obstruction.

Naples prognostic score as a novel prognostic prediction indicator in adult asthma patients: A population-based study

ObjectiveThis study was to evaluate the prognostic value of the Naples prognostic score (NPS) in adult patients with asthma. MethodsData on 44 601 participants from the 1999–2018 National Health and Nutrition Examination Survey (NHANES) were analyzed. The NPS was calculated based on serum albumin, total cholesterol, neutrophil-to-lymphocyte ratio (NLR), and lymphocyte-to-monocyte ratio (LMR), and participants were divided into 3 groups. Self-administered questionnaires were used to collect information on asthma, and mortality was identified using the National Death Index through December 31, 2019. Multiple logistic regressions were used to analyze the relationship between NPS and its components and the prevalence of asthma. Kaplan-Meier survival analysis, Cox proportional regressions, and the random survival forest (RSF) were used to assess the significance of NPS and its components in predicting all-cause and cause-specific (cardiovascular, cancer, and respiratory diseases) mortality in asthma patients. ResultsThe mean age of the participants was 47.59 ± 0.18 years, and 48.47% were male. The prevalence of asthma was 13.11%. The participants were categorized into 3 groups: 8306 (18.6%) participants were in group 0 (NPS 0), 30 842 (69.2%) were in group 1 (NPS 1 or 2), and 5453 (11.2%) were in group 2 (NPS 3 or 4). Compared to the reference group, participants in group 2 had a higher prevalence of asthma (odds ratio [OR] = 1.40 [1.24–1.56]). Participants with asthma in group 2 had a significantly increased risk of all-cause mortality (hazard ratio [HR] = 2.42 [1.67–3.50]), cardiovascular mortality (HR = 2.68 [1.50–4.79]), cancer mortality (HR = 2.10 [1.00–4.45]), and respiratory disease mortality (HR = 3.00 [1.18–7.65]) compared to those with asthma in group 0. The RSF showed that NPS had the highest value in predicting all-cause mortality in adults with asthma, compared to its components. ConclusionsThe results of this study indicate that the NPS is a powerful prognostic indicator for outcomes in asthma patients.

The value of the preoperative Naples prognostic score in predicting prognosis in gallbladder cancer surgery patients

PurposeThe Naples prognostic score (NPS) is a comprehensive prognostic model that includes inflammatory and nutrition-related indicators and is increasingly used as a prognostic score for various malignant tumors. Given its predictive effect on prognosis in patients with gallbladder cancer, it is currently unclear. This study aimed to investigate the role of preoperative NPS in predicting prognosis in gallbladder cancer surgery patients.Patients and methodsA retrospective analysis was performed for 135 patients who underwent radical surgery for gallbladder cancer without preoperative treatment between March 2011 and January 2020. NPS was calculated by measuring the preoperative total cholesterol value, serum albumin value, neutrophil–lymphocyte ratio (NLR), and lymphocyte-monocyte ratio (LMR). They were then divided into 3 groups (groups 0, 1, and 2) based on NPS scores. Survival analysis was performed using the Kaplan–Meier method and log-rank test. Univariate and multivariate Cox proportional hazards models were used to identify independent prognostic factors. Plot time-dependent receiver operating characteristic (ROC) curves to compare the prognostic value of scoring systems. Finally, a nomogram model was developed with independent prognostic factors.ResultsMultivariate analysis showed that NPS was an independent risk factor affecting OS (HR = 3.417, p < 0.05). The time-dependent ROC curve results showed that NPS had a better predictive value on survival prognosis than other indicators. The nomogram constructed according to independent factors such as NPS has a good predictive ability for OS.ConclusionAs a simple and reliable tool, the NPS has important predictive value in the survival prognosis of gallbladder cancer patients. The nomogram model constructed by NPS will help determine prognosis and make individualized treatment decisions.

A Novel Score to Predict One-Year Mortality after Transcatheter Aortic Valve Replacement, Naples Prognostic Score.

Background and Objectives: Aortic stenosis (AS) is a widespread valvular disease in developed countries, primarily among the elderly. Transcatheter aortic valve replacement (TAVR) has become a viable alternative to aortic valve surgery for patients with severe AS who are deemed a high surgical risk or for whom the AS is found to be inoperable. Predicting outcomes after TAVR is essential. The Naples Prognostic Score (NPS) is a new scoring method that evaluates nutritional status and inflammation. Our study is aims to examine the relationship between the NPS and outcomes for patients receiving TAVR. Material and Methods: We conducted a retrospective study of 370 patients who underwent TAVR across three tertiary medical centres from March 2019 to March 2023. The patients were divided into two groups based on their NPS, namely, low (0, 1, and 2) and high (3 and 4). Our study is primarily aimed to determine the one-year mortality rate. Results: Within one year, the mortality rate for the entire group was 8.6%. Nonetheless, the low-NPS group had a rate of 5.0%, whereas the high-NPS group had a rate of 13%. The difference between the two groups was statistically significant, with a p-value of 0.06. Conclusions: Our results show that NPS is an independent predictor of one-year mortality in patients undergoing TAVR.

Naples Prognostic Score is an Independent Prognostic Factor in Patients Undergoing Hepatectomy for Hepatocellular Carcinoma.

Nutritional and inflammatory status has been reported to be associated with the prognosis of hepatocellular carcinoma (HCC), but many studies did not include all biomarkers simultaneously. The present study aimed to determine the impact of Naples prognostic score (NPS) on the long-term survival in patients undergoing hepatectomy for HCC. Patients with HCC after curative resection were eligible. Then, all patients were stratified into three groups according to the NPS. Clinical features and survival outcomes were compared among the three groups. Independent prognostic factors were determined by COX analysis. The time dependent receiver operating characteristic (ROC) curves were used to compare prognostic performance with other immunonutrition scoring systems. A total of 476 patients were enrolled eventually. Baseline characteristics showed that patients with higher NPS had a higher proportion of poor liver function and advanced tumor features. Accordingly, Kaplan-Meier survival curves showed that patients with higher NPS had a lower rate of overall survival (OS) and recurrence-free survival (RFS). Multivariable COX analysis demonstrated that NPS was an independent risk factor of OS (NPS group 2 vs 1: HR=1.958, 95% CI: 1.038-3.369, p = 0.038; NPS group 3 vs 1: HR=2.608, 95% CI: 1.358-5.008, p=0.004, respectively) and RFS (NPS group 2 vs 1: HR=2.014, 95% CI: 1.299-2-3.124, p=0.002; NPS group 3 vs 1: HR=2.002, 95% CI: 1.262-3.175, p=0.003, respectively). The time-dependent ROC curve showed that NPS was superior to other models in prognostic performance and discriminatory power for long-term survival (median AUC 0.675, 95% CI: 0.586-0.712, P < 0.05). The NPS is a simple tool strongly associated with long-term survival in patients undergoing curative hepatectomy for HCC.

Assessment of Naples prognostic score in predicting survival for small cell lung cancer patients treated with chemoradiotherapy

Backgrounds The Naples prognosis score (NPS) is a novel prognostic biomarker-based immune and nutritional status and that can be used to evaluate prognosis. Our study aimed to investigate the prognostic role of NPS in SCLC patients. Methods Patients treated with chemoradiotherapy were retrospectively analyzed between June 2012 and August 2017. We divided patients into three groups depending on the NPS: group 0, n = 31; group 1, n = 100; and group 2, n = 48, and associations between clinical characteristics and NPS group were analyzed. The univariable and multivariable Cox analyses were used to evaluate the prognostic value of clinicopathological characteristics and laboratory indicators for overall survival (OS) and progression-free survival (PFS). Results Data from 179 patients were analyzed. Treatment modality (p < 0.001) and serum CEA (p = 0.03) were significantly different among the NPS groups. The age, sex, smoking status, KPS, Karnofsky performance score (KPS), disease extent, and number of metastatic sites were not correlated with NPS (all p > 0.05). KPS, disease extent, prophylactic cranial irradiation, treatment response and NPS Group were associated with OS. In addition, KPS, disease extent, prophylactic cranial irradiation, treatment response and NPS Group were associated with PFS. Multivariate analysis results showed that NPS was identified as an independent prognostic factor for OS (Group 1: hazard ratio [HR] = 2.704, 95% confidence interval [CI] = 1.403-5.210; p = 0.003; Group 2: HR = 5.154, 95% CI = 2.614-10.166; p < 0.001) and PFS (Group 1: HR = 2.018, 95% CI = 1.014-4.014; p = 0.045; Group 2: HR = 3.339, 95% CI = 1.650-6.756; p = 0.001). Conclusions NPS is related to clinical outcomes in patients with SCLC.

Keep It or Leave It? Comparison of Preoperative Scoring as Mortality Predictor Post-Pancreaticoduodenectomy.

Pancreaticoduodenectomy (PD) is the common procedure in resectable periampullary malignancies. However, the postoperative mortality rate for PD is relatively high. Mortality scoring system helps surgeons to decide patients' eligibility for surgery to minimize mortality risk. This study aimed to compare four scoring systems for mortality prediction after PD in the Indonesian population. In this cross-sectional study, data were retrospectively collected from medical records for patients who underwent PD due to periampullary malignancy between January 2010 and January 2022. We assessed scoring accuracy, cut-off, sensitivity, specificity, negative predictive value, positive predictive value, and area under the curve (AUC) of Naples prognostic score (NPS), Whipple-ABACUS (WA), modified Pitt score (MPS), and Pitt score. Of the 116 patients who met the criteria, the mortality rate was 12.1%. Mean age was 51.64 ± 10.22 years consist of 75.9% group <60 years and 24.1% ≥60 years, with 46.6% male and 53.4% female. The AUC from highest to lowest were Pitt Score 0.890 (p<0.001), MPS 0.775 (p 0.001), WA 0.627 (p 0.123), and NPS 0.505 (p 0.949) with the level of accuracy of each score were Pitt Score and MPS 67.2%, WA 50.0%, and NPS 59.5%. Pitt and MPS scores have the highest accuracy of all the scoring systems in this study. MPS has the advantage of having fewer components, making it easy to implement. MPS can replace the role of the Pitt Score in predicting post-procedure PD mortality in Indonesia. Further studies that include the intraoperative factors are needed to increase the scoring accuracy.

The Naples prognostic score in esophagus cancer: Prognostic and beyond

The role of inflammation in tumor biology has been better understood over time. The utility of the Naples prognostic score (NPS), which is a novel inflammation-based marker, was shown in esophageal carcinoma (EC) patients treated with surgery. We herein presented the prognostic and predictive value of NPS in EC patients treated with upfront chemoradiotherapy (CRT). Adult EC patients with squamous cell carcinoma or adenocarcinoma were included. Median survival was compared by log-rank test. Cox regression analyses were performed to establish the independent prognostic effect of NPS. Of 153 patients, 97 (63.4%) and 56 (36.6%) patients were treated with CRT alone and CRT followed by surgery, respectively. The median overall survival (OS) was significantly different among the Naples prognostic groups (NPG) (60+ months [CI 95%: NA], 27 months [CI 95%: 16.8-37.5], and 18.5 months [CI 95%: 15.3-30.7] for NPG 0,1, and 2, respectively; P=0.007). Surgery following CRT provided survival benefit in NPG 1 (65+ months with surgery vs. 17.3 months without surgery, P<0.001) and in NPG 2 (33 months with surgery vs. 15 months without surgery, P=0.009). Multivariate Cox regression analysis showed that the NPS is an independent prognostic marker for OS (HR is 1.28 for OS [CI 95%: 1.03-1.59], P=0.02). NPS might be useful as a prognostic marker in also EC patients treated with upfront CRT. Patients with high NPS may have a high risk of recurrence. Surgery might be planned in EC at the diagnosis in NPG 1 and 2.

The Osaka prognostic score and Naples prognostic score: novel biomarkers for predicting short-term outcomes after spontaneous intracerebral hemorrhage

ObjectivesPoor immune-nutritional status has been associated with an unfavorable outcome in critical illness. The Osaka prognostic score (OPS) and the Naples prognostic score (NPS), based on inflammatory and nutritional status, has been shown to predict prognosis following cancer and other diseases. The aim of this study was to investigate the relationship between the OPS and NPS and the short-term outcomes of patients with intracerebral hemorrhage (ICH).MethodsWe retrospectively analyzed the clinical data of patients hospitalized with spontaneous ICH (n = 340) at The Second Affiliated Hospital of Chongqing Medical University between August 2016 and August 2021. Inclusion criteria included patients aged between 18 and 70, and if a blood sample was taken for laboratory testing within 24 h of admission (serum C-reactive protein, albumin, total cholesterol, and counts for neutrophils, lymphocytes, and monocytes were collected on admission). Exclusion criteria included a non-spontaneous cause of ICH and patient death during hospitalization. Patients were divided into four groups based on OPS or five groups according to NPS. Outcomes were evaluated by the modified Rankin Scale (mRS) at six months post-ICH hospitalization. An unfavorable outcome was defined as a mRS score ≥ 3.ResultsA total of 289 patients met our inclusion criteria. The unfavorable outcome group had older age, a lower Glasgow Coma Scale score, a higher rate of complications and cerebral herniation, a longer hospital stay, and higher OPS and NPS when compared with the favorable outcome group. Univariate analysis showed that both OPS and NPS were strongly correlated with mRS (r = 0.196,P < 0.001; r = 0.244, P = 0.001, respectively). Multivariate analysis further showed that OPS and NPS were both independent predictors of unfavorable outcomes for patients with ICH with adjusted odds ratios of 1.802 (95% confidence interval [CI]:1.140–2.847, P = 0.012) and 1.702 (95% CI: 1.225–2.635, P = 0.02), respectively. The area under the curve (AUC) of NPS for predicting a poor outcome was 0.732 (95% CI: 0.665–0.799), which was similar to the AUC of OPS 0.724 (95% CI: 0.657–0.792).ConclusionsIn this cohort, a higher OPS and NPS on admission was associated with poor outcome at six months following ICH, supporting their potential role as markers for predicting the outcome of patients with ICH.

Comparison of Systemic Immune-Inflammation Index and Naples Prognostic Score for Prediction Coronary Artery Severity Patients Undergoing Coronary Computed Tomographic Angiography.

This study compared the predictive power of the systemic immune-inflammation index (SII) and Naples prognostic score (NPS) in determining the severity of coronary artery disease (CAD). The study included 1138 patients who underwent coronary computed tomographic angiography (CCTA). The primary outcome was the evaluation of CAD severity, determined by the Coronary Artery Disease-Reporting and Data System (CAD-RADS) obtained from the CCTA scans. A basic statistical model including age, gender, chest pain, diabetes mellitus, hypertension, hyperlipidemia, and smoking was built, and categorical variables, NPS (Naples 3,4 vs 0,1,2) and SII, were added to the basic statistical model. The net benefits of the predictive parameters were determined by a decision curve analysis, and the association between CAD-RADS and NPS, SII was quantified by odds ratios (OR) and 95% confidence intervals (CI). The decision curve analysis showed that adding SII to the statistical model had a better full range of probability of clinical net benefit compared with the baseline model (OR: 5.77, 95% CI 4.15-8.02, P < .001). However, adding the NPS (P = .11) to the model did not outperform the basic statistical model. In conclusion, the SII may have a net predictive effect on top of traditional risk factors.

Naples prognostic score may predict overall survival in metastatic pancreatic cancer.

Naples prognostic score (NPS) based on nutritional and inflammatory parameters can predict response to chemotherapy and overall survival (OS) in many cancer types. However, its significance in metastatic pancreatic cancer (PC) remains unclear. We evaluated the prognostic significance of the NPS in patients with metastatic PC receiving first line chemotherapy. We retrospectively analyzed 215 patients with metastatic PC receiving first line FOLFIRINOX chemotherapy. NPS's were calculated using pre-chemotherapy laboratory data. Patients were divided into three groups according to their scores (NPS: 0; 1 & 2; 3 & 4 were grouped as 1, 2 and 3, respectively). The association of NPS with clinicopathological features and OS were evaluated. Median age was 64 years, and median OS was 10.5 months. Hemoglobin levels were lower and Ca-19-9 values were higher with increasing NPS. Frequency of patients with bone and/or liver metastases, and with greater than 5 metastatic focus were higher in group 3. A lower NPS was associated with longer OS. The median OS in groups 1, 2, and 3 were 19.5, 12, and 8 months, respectively, and differed significantly. Univariate analysis revealed effect of NPS (3-4) on OS (HR: 2.38, 1.77-3.19). Other prognostic factors affecting OS were age, ECOG, liver, bone or lymph node metastases, number of metastatic foci (<5 vs >5), de-novo metastatic disease, and serum Ca-19-9 levels. NPS (3-4) was identified as an independent prognostic factor negatively affecting OS (HR: 1.89, 1.34-2.65) in multivariate analysis. NPS may be a useful prognostic marker for the prediction of OS in metastatic PC patients receiving systemic chemotherapy.

Is the Naples prognostic score useful for predicting heart failure mortality.

Aim The Naples prognostic score (NPS) simultaneously evaluates inflammation and malnutrition, which are two main factors that play a role in the pathophysiology and prognosis of heart failure (HF). In this study, we aimed to examine the relationship of NPS with in-hospital mortality of hospitalized patients with a diagnosis of HF.Material and Methods A total of 496 hospitalized HF patients included in this study. The patients were divided into two groups as deceased and living. The clinical and demographic characteristics of each patient were recorded. NPS of each patient was calculated.Results NPS was significantly higher in the deceased group compared to the living group (3.6±0.61, 3.21±0.97, respectively; p=0.003). According to multivariate regression analysis: NPS (OR: 1.546, 95 % CI: 1.027-2.327; p=0.037), systolic blood pressure (OR: 0.976, 95 % CI: 0.957-0.995; p=0.015), and white blood cell count (OR: 1.072, 95 % CI: 1.007-1142; p=0.03) are independent predictors for in-hospital mortality in HF patients.Conclusion This study demonstrated a strong correlation between NPS and mortality in HF. This new score can be used to predict the prognosis of HF as it shows both the level of inflammation and nutrition.

Prognostic significance of the Naples prognostic score in colorectal cancer patients undergoing curative resection: a propensity score matching analysis

BackgroundSystemic inflammation is recognized as a hallmark of cancer that contributes to tumor development and progression in various malignancies. The Naples prognostic score (NPS) was established as a prognostic indicator for colorectal cancer (CRC). This study aims to examine the predictive value of the NPS for survival in CRC patients undergoing curative resection by a propensity score matching (PSM) analysis.MethodsA total of 533 CRC patients were enrolled in this study. Overall survival (OS) and disease-free survival (DFS) were compared between high-NPS and low-NPS groups. A time-dependent receiver operator characteristic (ROC) curve analysis was conducted to calculate the area under curve (AUC) of the NPS for OS. A multivariable Cox-proportional hazards regression analysis and PSM analysis were used to identify independent prognostic factors for OS and DFS. We compared the predictive value of the NPS to that of the neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte ratio (PLR), Onodera prognostic nutritional index (PNI), and controlling nutritional status score (CONUT) for OS.ResultsHigh-NPS was significantly associated with worse OS and DFS. After PSM, 123 patients were included in each group. A multivariate analysis revealed that Age ≥ 68, ASA-PS ≥ 3, high NPS and undifferentiated tumor type were independently associated with OS, while high NPS, advanced T and N stage were independently associated with DFS after PSM. The NPS had the greatest AUC for OS in comparison to the NLR, LMR, PNI and CONUT.ConclusionsWe successfully validated the prognostic utility of the NPS for CRC patients after curative resection.

Predictive Value of the Naples Prognostic Score for Acute Kidney Injury in ST-Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention.

The purpose of this investigation was to investigate whether there was an association between the Naples prognostic score and the development of acute kidney injury (AKI) in ST-elevation myocardial infarction (STEMI) patients following primary percutaneous coronary intervention (pPCI). The study comprised 2901 consecutive STEMI patients who had pPCI. For each patient, the Naples prognostic score was determined. To evaluate the predictive performance of the Naples score (which included either continuous and categorical variables), we developed a Nested model and a nested model combined with the Naples score. The Naples prognostic score was the most significant predictor of AKI occurrence after admission creatinine, age, and contrast volume. The continuous Naples prognostic score model provided the best prediction performance and discriminative ability. The C-index of the Nested and full models with continuous Naples prognostic score were significantly higher than that of the Nested model. The decision curve analysis found that the overall model had a higher full range of probability of clinical net benefit than the baseline model, with a 10% AKI likelihood. The present study found that the Naples prognostic score may be useful to predict the risk of AKI in STEMI patients undergoing pPCI.

Predictive value of the Naples prognostic score on postoperative outcomes in patients with rectal cancer.

The Naples prognostic score (NPS) is a prognostic index based on the nutritional and inflammatory status. However, its utility in predicting postoperative complications (POCs) has not been examined in rectal cancer (RC). We evaluated the predictive value of the preoperative NPS for POCs in RC. We retrospectively analyzed 235 patients who underwent surgery for RC. The NPS was calculated based on serum albumin, serum total cholesterol, the neutrophil-to-lymphocyte ratio (NLR) and the lymphocyte-to-monocyte ratio (LMR). Severe POCs were defined as Clavien-Dindo classification grade ≥ III. The optimal cut-off value of the NPS was determined by a receiver operator characteristic (ROC) curve analysis. The NPS, NLR, LMR, platelet-to-lymphocyte ratio (PLR), C-reactive protein (CRP)-to-albumin ratio (CAR), Glasgow prognostic score (GPS), Onodera prognostic nutritional index (PNI) and controlling nutritional status score (CONUT) were investigated as inflammation-based and/or nutritional markers. Predictors of severe POCs were analyzed by logistic regression modeling. Severe POCs were observed in 64 patients (27.2%). Male sex, operation time (> 257min), blood loss (≥ 30mL), albumin (< 4.0g/dL), CRP (≥ 1.0mg/dL), total cholesterol (≤ 180mg/dL), NPS (≥ 2), LMR (≥ 3.48), PLR (≥ 103.6), CAR (> 0.025), GPS (≥ 1), PNI (< 48.1) and CONUT (≥ 2) were significantly associated with severe POCs. The multivariate analysis revealed that male sex, operation time (> 257min), and a high NPS (≥ 2) were independent predictors of severe POCs. The ROC curve analysis revealed that the NPS had the greatest predictive value among the inflammation-based and/or nutritional markers. The NPS is a valuable predictor of severe POCs in RC.

Prognostic value of preoperative immune-nutritional scoring systems in remnant gastric cancer patients undergoing surgery.

Remnant gastric cancer (GC) is defined as GC that occurs five years or more after gastrectomy. Systematically evaluating the preoperative immune and nutritional status of patients and analyzing its prognostic impact on postoperative remnant gastric cancer (RGC) patients are crucial. A simple scoring system that combines multiple immune or nutritional indicators to identify nutritional or immune status before surgery is necessary. To evaluate the value of preoperative immune-nutritional scoring systems in predicting the prognosis of patients with RGC. The clinical data of 54 patients with RGC were collected and analyzed retrospectively. Prognostic nutritional index (PNI), controlled nutritional status (CONUT), and Naples prognostic score (NPS) were calculated by preoperative blood indicators, including absolute lymphocyte count, lymphocyte to monocyte ratio, neutrophil to lymphocyte ratio, serum albumin, and serum total cholesterol. Patients with RGC were divided into groups according to the immune-nutritional risk. The relationship between the three preoperative immune-nutritional scores and clinical characteristics was analyzed. Cox regression and Kaplan-Meier analysis was performed to analyze the difference in overall survival (OS) rate between various immune-nutritional score groups. The median age of this cohort was 70.5 years (ranging from 39 to 87 years). No significant correlation was found between most pathological features and immune-nutritional status (P > 0.05). Patients with a PNI score < 45, CONUT score or NPS score ≥ 3 were considered to be at high immune-nutritional risk. The areas under the receiver operating characteristic curves of PNI, CONUT, and NPS systems for predicting postoperative survival were 0.611 [95% confidence interval (CI): 0.460-0.763; P = 0.161], 0.635 (95%CI: 0.485-0.784; P = 0.090), and 0.707 (95%CI: 0.566-0.848; P = 0.009), respectively. Cox regression analysis showed that the three immune-nutritional scoring systems were significantly correlated with OS (PNI: P = 0.002; CONUT: P = 0.039; NPS: P < 0.001). Survival analysis revealed a significant difference in OS between different immune-nutritional groups (PNI: 75 mo vs 42 mo, P = 0.001; CONUT: 69 mo vs 48 mo, P = 0.033; NPS: 77 mo vs 40 mo, P < 0.001). These preoperative immune-nutritional scores are reliable multidimensional prognostic scoring systems for predicting the prognosis of patients with RGC, in which the NPS system has relatively effective predictive performance.

Naples Prognostic Score as an Independent Predictor of Survival Outcomes for Resected Locally Advanced Non-Small Cell Lung Cancer Patients After Neoadjuvant Treatment.

The Naples Prognostic Score (NPS) can reflect patient's nutritional and inflammatory status, which is identified as a prognostic indicator for various malignant tumors. However, its significance in patients with resected locally advanced non-small cell lung cancer (LA-NSCLC) patients who receive neoadjuvant treatment remains unclear so far. A total of 165 LA-NSCLC patients surgically treated from May 2012 to November 2017 were retrospectively investigated. The LA-NSCLC patients were divided into three groups according to NPS scores. The receiver operating curve (ROC) analysis was performed to reveal the discriminatory ability of NPS and other indicators for predicting the survival. The NPS and clinicopathological variables were further evaluated the prognostic value by univariate and multivariate Cox analysis. The NPS was related to age (P = 0.046), smoking history (P = 0.004), Eastern Cooperative Oncology Group (ECOG) score (P = 0.005), and adjuvant treatment (P = 0.017). Patients with high NPS scores had worse overall survival (OS) (group 1 vs 0, P = 0.006; group 2 vs 0, P < 0.001) and disease-free survival (DFS) (group 1 vs 0, P < 0.001; group 2 vs 0, P < 0.001). The ROC analysis demonstrated that NPS had better predictive ability than other prognostic indicators. Multivariate analysis revealed that NPS was independent prognostic indicator of OS (group 1 vs 0, hazard ratio [HR] =2.591, P = 0.023; group 2 vs 0, HR = 8.744, P = 0.001) and DFS (group 1 vs 0, HR =3.754, P < 0.001; group 2 vs 0, HR = 9.673, P < 0.001). The NPS could be an independent prognostic indicator in patients with resected LA-NSCLC receiving neoadjuvant treatment and more reliable than the other nutritional and inflammatory indicators.

Inflammatory and Nutritional Status Influences Outcomes of Minimally Invasive Esophagectomy.

The potential association between severe postoperative complications (SPC) and the oncological outcomes of esophageal squamous cell carcinoma (ESCC) patients according to the different Naples Prognostic Score (NPS) of the inflammatory nutritional status after minimally invasive esophagectomy (MIE) is unclear. Kaplan-Meier survival analysis was used to evaluate overall survival (OS) and disease-free survival (DFS) between with or without SPC (Clavien-Dindo grade ≥ III) in low NPS status (NPS = 0 or 1) and high NPS status (NPS = 2 or 3 or 4) patients. Cox multivariable analysis was carried out to analyze the various independent factors of OS and DFS, and a nomogram based on SPC was established. A total of 20.7% (125/604) ESCC patients developed SPC after MIE. Patients with SPC exhibited poor 5-year OS and DFS compared to those without SPC (all P < 0.001). Further analysis revealed that SPC significantly reduced OS and DFS in patients with high NPS status (all P < 0.001) but had little effect on the prognosis of patients with low NPS status (all P > 0.05). Multivariable Cox analysis revealed that SPC could be an independent influence indicator for OS and DFS in patients with high NPS status. Therefore, a novel nomogram combining SPC and tumor-node-metastasis (TNM) staging has been developed, which was found to be relatively more accurate in predicting OS and DFS than TNM staging alone. Severe complications can adversely affect the long-term oncological outcome of ESCC patients with high systemic inflammatory response and malnutrition after MIE.