Inflammatory and nutritional status is a predictor of long-term outcome in patients undergoing surgery for gastric cancer. Validation of the Naples prognostic score

Abstract

PURPOSE: Oncological outcome depends not only on tumor behaviour but also on nutritional and immune-inflammatory host status. Data in gastric cancer are limited. The main aim of this study was to prospectively assess Naples prognostic score (NPS) in gastric cancer patients. NPS was also compared with prognostic nutritional index (PNI), controlling nutritional status (CONUT) score and systemic inflammation score (SIS).

METHODS: Overall survival (OS) and complication rates of 415 patients undergoing gastric cancer surgery from January 2000 to December 2015 were calculated. Disease-free survival (DFS) rates were assessed in 307 radically resected patients.

MaxStat analysis was used to identify the best cut-off values. NPS scores were divided into 3 groups (NPS 0-3). The receiver-operating-characteristic (ROC) curve for censored survival data was used to compare the prognostic performance of scoring systems.

RESULTS: NPS positively correlated with current scoring systems (p<0.001) and advanced tumor stages (p<0.001). Patients with elevated NPS scores experienced more postoperative complications (all patients: p=0.003; radically resected patients: p=0.010). NPS1 and NPS2 patients had a higher hazard ratio (HR) than NPS0 patients for OS (NPS1 HR 2.04, NPS2 HR 4.27; p<0.001) and DFS (NPS1 HR 1.70, NPS2 HR 4.98; p<0.001). Among the different scoring systems, only NPS was selected as an independent significant predictor for OS (p=0.024) and DFS (p=0.009). NPS was assigned the best prognostic performance by ROC analysis, equalling TNM staging system, and correctly identified highrisk patients.

CONCLUSIONS: NPS is an easy to calculate prognostic score strongly associated with outcome in patients undergoing gastric cancer surgery.