Xu Xue-Lian, Cheng Hao
Department of Radiotherapy Oncology, the First Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, People's Republic of China.
Department of Radiotherapy Oncology, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China.
J Inflamm Res. 2025 Jun 5;18:7243-7262. doi: 10.2147/JIR.S521901. eCollection 2025.
Hypopharyngeal squamous cell carcinoma (HSCC) is a rare yet highly aggressive malignant tumor of the head and neck. This study aims to investigate the clinical factors influencing the prognosis of HSCC and develop a prognostic prediction model combining inflammation-nutrition indicators, such as the Naples Prognostic Score (NPS).
A retrospective analysis was conducted on clinical data from 292 hSCC patients who underwent radical surgery between 2007 and 2019. Univariate and multivariate Cox regression analyses were used to identify the independent prognostic factors affecting disease-free survival (DFS) and overall survival (OS). Finally, the nomogram models for predicting 3-year and 5-year DFS and OS were constructed and validated based on these factors.
This study included 292 hSCC patients, with a median age of 51 years. The nomograms were developed using Cox regression to predict 3- and 5-year DFS and OS, incorporating factors such as adjuvant radiotherapy, age-adjusted Charlson comorbidity index (ACCI), Naples prognostic score (NPS), and surgical safety margin. The nomograms demonstrated strong predictive performance with area under the curve (AUC) values >0.78 in both training and validation sets. It outperformed the American Joint Committee on Cancer (AJCC) staging system in terms of discriminative power, clinical utility, and reclassification, as confirmed by decision curve analysis (DCA), concordance index (C-indices), integrated discrimination improvement (IDI), and net reclassification improvement (NRI). Patients were categorized into high-, medium-, and low-risk groups based on total risk points, with significant differences in DFS and OS observed across these groups. Furthermore, the study found that adjuvant radiotherapy significantly improved survival in high-risk and medium-risk patients, while low-risk patients did not benefit.
The results suggest that NPS is an independent prognostic factor for HSCC, and the nomogram model incorporating NPS can provide important references for individualized treatment decisions and offer new perspectives for clinical prognostic assessment.
下咽鳞状细胞癌（HSCC）是一种罕见但侵袭性很强的头颈部恶性肿瘤。本研究旨在探讨影响HSCC预后的临床因素，并建立一个结合炎症-营养指标（如那不勒斯预后评分（NPS））的预后预测模型。
对2007年至2019年间接受根治性手术的292例HSCC患者的临床资料进行回顾性分析。采用单因素和多因素Cox回归分析来确定影响无病生存期（DFS）和总生存期（OS）的独立预后因素。最后，基于这些因素构建并验证了预测3年和5年DFS及OS的列线图模型。
本研究纳入292例HSCC患者，中位年龄为51岁。使用Cox回归建立列线图以预测3年和5年DFS及OS，纳入了辅助放疗、年龄校正的查尔森合并症指数（ACCI）、那不勒斯预后评分（NPS）和手术切缘等因素。列线图在训练集和验证集中均表现出强大的预测性能，曲线下面积（AUC）值>0.78。决策曲线分析（DCA）、一致性指数（C指数）、综合判别改善（IDI）和净重新分类改善（NRI）证实，在判别能力、临床效用和重新分类方面，其优于美国癌症联合委员会（AJCC）分期系统。根据总风险点数将患者分为高、中、低风险组，各组间DFS和OS存在显著差异。此外，研究发现辅助放疗显著改善了高风险和中风险患者的生存期，而低风险患者未从中获益。
结果表明，NPS是HSCC的独立预后因素，纳入NPS的列线图模型可为个体化治疗决策提供重要参考，并为临床预后评估提供新的视角。
