Hosoda Kiyotaka, Shimizu Akira, Kubota Koji, Notake Tsuyoshi, Kitagawa Noriyuki, Yoshizawa Takahiro, Sakai Hiroki, Hayashi Hikaru, Yasukawa Koya, Soejima Yuji
Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation, and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
World J Surg. 2025 Feb;49(2):502-511. doi: 10.1002/wjs.12448. Epub 2024 Dec 4.
The Naples prognostic score (NPS) is a remarkable marker of short- and long-term outcomes in various types of cancer. However, its impact on the postoperative outcomes of hepatocellular carcinoma remains controversial. This study aimed to clarify the impact of the NPS on the prognosis and incidence of postoperative complications in hepatocellular carcinoma.
Patients with hepatocellular carcinoma (n = 374) were categorized into high- and low-Naples prognostic score groups; their postoperative outcomes were compared. Prognostic and risk factors for severe postoperative complications were identified using multivariate analyses.
The low-Naples prognostic score group had significantly longer overall and recurrence-free survivals than the high-Naples prognostic score group (p = 0.03 and 0.04, respectively). Subgroup analysis revealed a superior predictive value of the NPS in the group with a single tumor (p = 0.03), tumor diameter ≤5 cm (p = 0.04), and tumor stage I or II (p = 0.04). A high NPS was an independent prognostic factor for overall survival (hazard ratio, 1.45; 95% confidence interval (CI), 1.01-2.05; and p = 0.04). The NPS 2-4 group had a higher incidence of the Clavien-Dindo grade ≥ IIIa postoperative complications than the 0-1 group (p = 0.03) and a score of 2-4 was identified as an independent risk factor for the Clavien-Dindo grade ≥ IIIa postoperative complications (odds ratio, 2.06; 95% CI, 1.01-4.20; and p = 0.05).
The NPS effectively predicts postoperative outcomes in patients with hepatocellular carcinoma.
那不勒斯预后评分（NPS）是各类癌症短期和长期预后的重要标志物。然而，其对肝细胞癌术后预后的影响仍存在争议。本研究旨在阐明NPS对肝细胞癌预后及术后并发症发生率的影响。
将374例肝细胞癌患者分为高、低那不勒斯预后评分组，比较两组术后预后情况。采用多因素分析确定术后严重并发症的预后及危险因素。
低那不勒斯预后评分组的总生存期和无复发生存期均显著长于高那不勒斯预后评分组（分别为p = 0.03和0.04）。亚组分析显示，NPS在单发肿瘤组（p = 0.03）、肿瘤直径≤5 cm组（p = 0.04）和肿瘤分期I或II组（p = 0.04）中具有更高的预测价值。高NPS是总生存期的独立预后因素（风险比，1.45；95%置信区间[CI]，1.01 - 2.05；p = 0.04）。NPS 2 - 4组Clavien - Dindo≥IIIa级术后并发症的发生率高于0 - 1组（p = 0.03），且评分为2 - 4被确定为Clavien - Dindo≥IIIa级术后并发症的独立危险因素（比值比，2.06；95% CI，1.01 - 4.20；p = 0.05）。
NPS能有效预测肝细胞癌患者的术后预后。
