Xu Xue-Lian, Cheng Hao
Department of Radiotherapy Oncology, the First Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, 453100, People's Republic of China.
Department of Radiotherapy Oncology, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, 450000, People's Republic of China.
J Inflamm Res. 2025 Jan 7;18:325-345. doi: 10.2147/JIR.S500518. eCollection 2025.
The Naples prognostic score (NPS) and its relation to the prognosis of oral squamous cell carcinoma (OSCC) have been inconclusive. This study aimed to investigate the correlation between NPS and the prognosis of postoperative OSCC patients. Additionally, the study sought to develop a new nomogram for predicting disease-free survival (DFS) and overall survival (OS).
The study included 576 OSCC patients who underwent surgical treatment at two hospitals between August 2008 and June 2018. Univariate and multivariate Cox regression analyses were conducted to identify independent prognostic factors. Subsequently, two nomograms were developed to predict DFS and OS based on these factors and underwent rigorous validation.
The median DFS and OS were 31.5 months and 36.5 months, respectively. Significant differences in DFS and OS were observed among patients with different NPS scores. Adjuvant radiotherapy, age-adjusted Charlson comorbidity index (ACCI), extranodal extension (ENE), NPS, American Joint Committee on Cancer (AJCC) stage, surgical safety margin, eastern cooperative oncology group performance status (ECOG PS), and systemic inflammation score (SIS) were identified as independent predictors of DFS and OS. In the training cohort, the nomogram's concordance index (C-index) for predicting DFS and OS was 0.701 and 0.693, respectively. In the validation group, the corresponding values were 0.642 and 0.635, respectively. Calibration plots confirmed a high level of agreement between the model's predictions and actual outcomes. Decision curve analysis (DCA) demonstrated the nomogram's good clinical utility. Additionally, patients in the low-risk group did not benefit from adjuvant radiotherapy, while those in the medium-risk and high-risk group could benefit from adjuvant radiotherapy.
NPS significantly influences the prognosis of OSCC patients following surgery. The nomogram developed in this study holds significant clinical application potential. The low-risk subgroup of patients was not required to undergo postoperative radiotherapy.
那不勒斯预后评分（NPS）及其与口腔鳞状细胞癌（OSCC）预后的关系尚无定论。本研究旨在探讨NPS与OSCC术后患者预后之间的相关性。此外，该研究试图开发一种新的列线图来预测无病生存期（DFS）和总生存期（OS）。
该研究纳入了2008年8月至2018年6月期间在两家医院接受手术治疗的576例OSCC患者。进行单因素和多因素Cox回归分析以确定独立的预后因素。随后，基于这些因素开发了两个列线图来预测DFS和OS，并进行了严格的验证。
DFS和OS的中位数分别为31.5个月和36.5个月。不同NPS评分的患者在DFS和OS方面存在显著差异。辅助放疗、年龄校正的Charlson合并症指数（ACCI）、结外扩展（ENE）、NPS、美国癌症联合委员会（AJCC）分期、手术安全切缘、东部肿瘤协作组体能状态（ECOG PS）和全身炎症评分（SIS）被确定为DFS和OS的独立预测因素。在训练队列中，预测DFS和OS的列线图一致性指数（C指数）分别为0.701和0.693。在验证组中，相应的值分别为0.642和0.635。校准图证实了模型预测与实际结果之间的高度一致性。决策曲线分析（DCA）表明列线图具有良好的临床实用性。此外，低风险组患者未从辅助放疗中获益，而中风险和高风险组患者可从辅助放疗中获益。
NPS显著影响OSCC患者术后的预后。本研究开发的列线图具有显著的临床应用潜力。低风险亚组患者无需接受术后放疗。
