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. 2025 Feb;49(2):502-511.
doi: 10.1002/wjs.12448. Epub 2024 Dec 4.

Clinical significance of the Naples prognostic score in predicting short- and long-term postoperative outcomes of patients with hepatocellular carcinoma

Kiyotaka Hosoda  1 , Akira Shimizu  1 , Koji Kubota  1 , Tsuyoshi Notake  1 , Noriyuki Kitagawa  1 , Takahiro Yoshizawa  1 , Hiroki Sakai  1 , Hikaru Hayashi  1 , Koya Yasukawa  1 , Yuji Soejima  1
Affiliations

Clinical significance of the Naples prognostic score in predicting short- and long-term postoperative outcomes of patients with hepatocellular carcinoma

Kiyotaka Hosoda et al. World J Surg. 2025 Feb.

Abstract

Background: 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.

Methods: 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.

Results: 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).

Conclusions: The NPS effectively predicts postoperative outcomes in patients with hepatocellular carcinoma.

Keywords: hepatocellular carcinoma; outcome; postoperative complication; prognosis; risk factor.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Patient selection criteria flowchart. NPS, Naples prognostic score.
FIGURE 2
FIGURE 2
Kaplan–Meier curves for the overall survival (OS) and recurrence‐free survival (RFS) of the participants stratified by high‐ and low‐NPS groups. The OS (A) and RFS (B) of the high‐NPS group are significantly lower than that of the low‐NPS group (OS, p = 0.03 and RFS, p = 0.04). NPS, Naples prognostic score; OS, overall survival; RFS, recurrence‐free survival.
FIGURE 3
FIGURE 3
Subgroup analysis for the survival predictability of the Naples prognostic score (NPS). A high NPS is a significant prognostic factor for overall survival in patients with single tumor (p = 0.03), small tumor (diameter <5 cm) (p = 0.04), and tumor stage I or II (p = 0.04). NPS, Naples prognostic score.
FIGURE 4
FIGURE 4
Receiver operating characteristic curve analysis of the Naples prognostic score (NPS) for postoperative complications with CD grade ≥ IIIa. The area under the curve value is 0.62 and the optimal cutoff value is NPS score 2. CD, Clavien–Dindo classification; NPS, Naples prognostic score.
See this image and copyright information in PMC

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