Prognostic significance of preoperative Naples prognostic score on short- and long-term outcomes after pancreatoduodenectomy for ampullary carcinoma

Abstract

Background: The Naples prognostic score (NPS) is an effective and objective tool to assess the immune-nutritional status of patients with malignant tumors. The aim of this study was to investigate the clinical significance of preoperative NPS on short- and long-term outcomes after pancreatoduodenectomy (PD) for ampullary carcinoma.

Methods: We retrospectively analyzed 404 consecutive patients with ampullary carcinoma who underwent PD between January 2012 and June 2018. Preoperative NPS was calculated from serum albumin and total cholesterol concentrations, and the neutrophil-lymphocyte ratio and lymphocyte-monocyte ratio (LMR). Patients were then divided into three groups according to their NPS. Clinicopathological variables, postoperative outcomes, and survival data were compared between the three groups. Univariate and multivariate Cox analysis of overall survival (OS) and recurrence-free survival (RFS) were also conducted, and time-dependent receiver operating characteristic (ROC) curves were created to evaluate the discriminatory ability of the prognostic scoring systems.

Results: Patients with higher NPS had worse prognosis, and significant OS difference (group 0 vs. 1, P=0.02; group 1 vs. 2, P<0.001; group 0 vs. 2, P<0.001) and RFS difference (group 0 vs. 1, P=0.088; group 1 vs. 2, P<0.001; group 0 vs. 2, P<0.001). Multivariate analysis revealed that NPS was an independent significant predictor of OS (grade 2 vs. grade 1 or 0, hazard ratio: 3.067; P<0.001) and RFS (grade 2 vs. grade 1 or 0, hazard ratio: 2.732; P<0.001). The time-dependent receiver operating curve analysis showed that NPS had better prognostic performance for OS and RFS than other prognostic models. Additionally, significant differences in the incidence of postoperative morbidity were observed between the three groups, and the NPS was an independent risk factor of overall postoperative complications (grade 2 vs. grade 1 or 0, odds ratio: 1.692; P=0.02).

Conclusions: The NPS was an independent predictor of overall- and RFS in patients undergoing PD for ampullary carcinoma, and was independently associated with the incidence of postoperative complications.

Keywords: Naples prognostic score (NPS); ampullary carcinoma; immune-nutritional status; postoperative outcomes; prognostic factor.

Figure 1

Flow diagram of study population selected.

Figure 2

Kaplan-Meier curves for overall survival (A) and recurrence-free survival (B). (A) Significant overall survival difference were observed between the three groups (group 0 vs. 1, P=0.02; group 1 vs. 2, P<0.001; group 0 vs. 2, P<0.001). (B) There was a significant recurrence-free survival difference between group 1 and group 2, and between group 0 and group 2 (P<0.001, P<0.001, respectively), no significant difference between group 0 and group 1 (P=0.088).

Figure 3

Comparison of the predictive accuracy of the different prognostic systems, by the time-dependent receiver operating characteristic analysis. The horizontal axis represents months after surgery, the vertical axis represents the AUC. (A) Overall survival (404 patients who underwent pancreatoduodenectomy for ampullary carcinoma). (B) Recurrence-free survival (375 patients who underwent pancreatoduodenectomy for ampullary carcinoma, excluded patients who with positive resection margin and died within 90 days of surgery). TNM stage according to the 8th edition of the Cancer Staging Manual of the American Joint Commission on Cancer. AUC, area under the curve; NPS, Naples prognostic score; SIS, systemic inflammation score; CONUT, controlling nutritional status; PNI, prognostic nutritional index; NRI, nutritional risk index.