Naples Prognostic Score as a Novel Prognostic Prediction Tool for Resectable Locally Advanced Esophageal Squamous Cell Carcinoma After Neoadjuvant Therapy

Weiming Chen,1– 3,* Guobing Xu,1– 3,* Xin Yan,4,* Shuo Wang,1– 3 Qichang Xie,1– 3 Qing Liu,5 Bin Zheng,1– 3 Chun Chen,1– 3 Yong Zhu,1– 3 Zhang Yang1– 3 1Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, People’s Republic of China; 2Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fuzhou, Fujian, People’s Republic of China; 3Clinical Research Center for Thoracic Tumors of Fujian Province, Fuzhou, Fujian, People’s Republic of China; 4Department of Cardiac Medical Center Nursing, Fujian Medical University Union Hospital, Fuzhou, Fujian, People’s Republic of China; 5Oncology Department of Fujian Medical university Union Hospital, Fuzhou, Fujian, People’s Republic of China*These authors contributed equally to this workCorrespondence: Zhang Yang, Department of Thoracic Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, Fujian, 350001, People’s Republic of China, Email [email protected] Yong Zhu, Department of Thoracic Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, Fujian, 350001, People’s Republic of China, Email [email protected]: Esophageal squamous cell carcinoma (ESCC) is a highly invasive malignancy with poor prognosis, especially in its locally advanced stages. Recent studies have highlighted the role of inflammation and nutrition in cancer prognosis. The Naples prognostic score (NPS), which integrates inflammatory and nutritional markers, has demonstrated prognostic value in various cancers. However, its applicability in patients with resectable locally advanced ESCC after neoadjuvant therapy remains unexplored. This study aimed to evaluate the prognostic value of the NPS in predicting overall survival (OS) and progression-free survival (PFS) in these patients.Patients and Methods: A retrospective study was conducted on 175 patients with locally advanced ESCC who underwent neoadjuvant therapy followed by surgical resection at Fujian Medical University Union Hospital between 2016– 2020. Patients were grouped by NPS scores (0,1– 2,3-4). Survival analysis was performed using the Kaplan-Meier method, and the predictive accuracy of NPS was evaluated using receiver operating characteristic (ROC) curves. Cox proportional hazards regression models were used to identify independent prognostic factors for OS and PFS.Results: Significant differences in OS (p=0.0025) and PFS (p=0.0018) were observed across the three NPS groups. Multivariable Cox regression analysis confirmed that patients with higher NPS scores (NPS group 2) had significantly worse OS (HR = 2.768, 95% CI: 1.239– 6.183, p = 0.013) and PFS (HR = 3.345, 95% CI: 1.574– 7.109, p = 0.002). The area under the curve (AUC) for NPS was 0.63 for OS and 0.67 for PFS, indicating moderate predictive value.Conclusion: The NPS is a simple and effective prognostic tool for assessing survival outcomes in patients with resectable locally advanced ESCC following neoadjuvant therapy. Its integration into clinical practice may aid in better stratification and treatment decision-making for these patients.Keywords: NPS score, esophageal squamous cell carcinoma, neoadjuvant therapy, prognostic assessment, overall survival, progression-free survival