Ran Jingyi, Liu Yalian, Yi Xiaoxi, Zhang Fujun
Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China.
J Inflamm Res. 2025 Aug 24;18:11593-11610. doi: 10.2147/JIR.S537870. eCollection 2025.
The Naples Prognostic Score (NPS) is a composite index that combines serum albumin (ALB), total cholesterol (TC), neutrophil-to-lymphocyte ratio (NLR), and lymphocyte-to-monocyte ratio (LMR). It has proven prognostic value across various cancers. However, its use in oral squamous cell carcinoma (OSCC) has not been sufficiently recognized for disease-specific characteristics. This study aimed to create and validate a modified NPS (mNPS) specifically for OSCC, comparing its prognostic effectiveness to that of the conventional NPS and other established indices.
A total of 479 patients with histologically confirmed OSCC who underwent curative-intent surgery between 2012 and 2019 were enrolled. Patients were randomly assigned to development (n=335) and validation (n=144) cohorts. Cohort-specific optimal cut-off values for ALB, TC, NLR, and LMR were determined using X-Tile software to construct the mNPS. Prognostic performance of mNPS was compared with conventional NPS, SII, SIRI, and CONUT using ROC analysis, C-index, and Cox regression. A nomogram incorporating mNPS and other independent risk factors was constructed and validated.
Multivariate Cox regression confirmed mNPS as an independent predictor of OS (Group 1: HR 2.18; Group 2: HR 3.10; P<0.01). The mNPS-based nomogram showed superior prognostic accuracy for 1-, 3-, and 5-year OS with AUCs of 0.83, 0.80, and 0.83 in the development cohort, and 0.80, 0.79, and 0.82 in the validation cohort. Corresponding C-index values were 0.73 (OS), 0.72 (DFS), and 0.73 (DSS) in the development cohort, and 0.74, 0.71, and 0.76 in the validation cohort, all outperforming the NPS-based model. Calibration and decision curve analyses confirmed the model's robustness and clinical utility.
Through OSCC-specific threshold recalibration, mNPS demonstrated improved prognostic discrimination compared with conventional indices. Incorporating mNPS into a nomogram enhances individualized risk stratification and provides a practical tool for guiding clinical decision-making in OSCC.
那不勒斯预后评分（NPS）是一种综合指数，它结合了血清白蛋白（ALB）、总胆固醇（TC）、中性粒细胞与淋巴细胞比值（NLR）以及淋巴细胞与单核细胞比值（LMR）。它已被证明在各种癌症中具有预后价值。然而，由于口腔鳞状细胞癌（OSCC）的疾病特异性特征，其在OSCC中的应用尚未得到充分认识。本研究旨在创建并验证一种专门针对OSCC的改良NPS（mNPS），并将其预后有效性与传统NPS和其他既定指标进行比较。
共纳入479例在2012年至2019年间接受根治性手术且组织学确诊为OSCC的患者。患者被随机分配到开发队列（n = 335）和验证队列（n = 144）。使用X-Tile软件确定ALB、TC、NLR和LMR在各队列中的最佳截断值，以构建mNPS。使用ROC分析、C指数和Cox回归将mNPS的预后性能与传统NPS、SII、SIRI和CONUT进行比较。构建并验证了一个包含mNPS和其他独立危险因素的列线图。
多变量Cox回归证实mNPS是OS的独立预测因子（第1组：HR 2.18；第2组：HR 3.10；P<0.01）。基于mNPS的列线图在1年、3年和5年OS方面显示出卓越的预后准确性，开发队列中的AUC分别为0.83、0.80和0.83，验证队列中的AUC分别为0.80、0.79和0.82。开发队列中相应的C指数值在OS方面为0.73，DFS方面为0.72，DSS方面为0.73，验证队列中分别为0.74、0.71和0.76，均优于基于NPS的模型。校准和决策曲线分析证实了该模型的稳健性和临床实用性。
通过对OSCC进行特定阈值重新校准，mNPS与传统指标相比，预后判别能力有所提高。将mNPS纳入列线图可增强个体化风险分层，并为指导OSCC临床决策提供实用工具。
