A Naples prognostic score-based nomogram enhances perioperative risk stratification for resected pancreatic cancer

Background The Naples Prognostic Score (NPS), integrating nutritional and inflammatory markers, may improve perioperative risk assessment in pancreatic ductal adenocarcinoma (PDAC). We evaluated the prognostic value of preoperative NPS in resected PDAC and developed an internally validated nomogram for overall survival.Methods This retrospective single-center study included 349 patients who underwent curative-intent resection for PDAC between 2014 and 2020. Patients were randomly assigned to a training cohort (n = 174) and a validation cohort (n = 175). NPS was calculated using preoperative albumin, total cholesterol, neutrophil-to-lymphocyte ratio, and lymphocyte-to-monocyte ratio. Cox regression identified independent predictors of overall survival. A nomogram incorporating NPS, TNM stage, and adjuvant chemotherapy was developed and evaluated using the concordance index, time-dependent receiver operating characteristic curves, calibration, and decision curve analysis.Results Preoperative NPS remained an independent predictor of survival in both cohorts. Compared with TNM stage alone, the nomogram demonstrated better discrimination, with higher C-index and area under the curve values at 1, 2, and 3 years. Calibration and decision curve analyses suggested good agreement and potential clinical benefit.Conclusion Preoperative NPS may complement conventional staging after PDAC resection. This NPS-based nomogram improved prognostic stratification, but external multicenter validation is required before routine clinical application.