The Naples prognostic score in esophagus cancer: Prognostic and beyond.

Objectives: The role of inflammation in tumor biology has been better understood over time. The utility of the Naples prognostic score (NPS), which is a novel inflammation-based marker, was shown in esophageal carcinoma (EC) patients treated with surgery. We herein presented the prognostic and predictive value of NPS in EC patients treated with upfront chemoradiotherapy (CRT).

Methods: Adult EC patients with squamous cell carcinoma or adenocarcinoma were included. Median survival was compared by log-rank test. Cox regression analyses were performed to establish the independent prognostic effect of NPS.

Results: Of 153 patients, 97 (63.4%) and 56 (36.6%) patients were treated with CRT alone and CRT followed by surgery, respectively. The median overall survival (OS) was significantly different among the Naples prognostic groups (NPG) (60+ months [CI 95%: NA], 27 months [CI 95%: 16.8-37.5], and 18.5 months [CI 95%: 15.3-30.7] for NPG 0,1, and 2, respectively; P=0.007). Surgery following CRT provided survival benefit in NPG 1 (65+ months with surgery vs. 17.3 months without surgery, P<0.001) and in NPG 2 (33 months with surgery vs. 15 months without surgery, P=0.009). Multivariate Cox regression analysis showed that the NPS is an independent prognostic marker for OS (HR is 1.28 for OS [CI 95%: 1.03-1.59], P=0.02).

Conclusion: NPS might be useful as a prognostic marker in also EC patients treated with upfront CRT. Patients with high NPS may have a high risk of recurrence. Surgery might be planned in EC at the diagnosis in NPG 1 and 2.