Assessment of Naples prognostic score in predicting survival for small cell lung cancer patients treated with chemoradiotherapy

Figures & data

Figure 1. Definition and Grouping for NPS. Point score 0 as NPS group 0; Point score 1 or 2 as NPS group 1; Point score 3 or 4 as NPS group 2. Abbreviations: neutrophil to lymphocyte ratio (NLR), lymphocyte to monocyte ratio (LMR), Naples prognostic score (NPS).

Table 1. Patients characteristics.

Characteristic	Values
Age (years)
<60	81(45.3)
≥60	98(54.7)
Sex
Male	99(55.3)
Female	80(44.7)
Smoking status
No-smoker	112(62.6)
Smoker	67(37.4)
KPS
90-100	132(73.4)
70-80	47(26.6)
Disease extent
LD	65(53.3)
ED	114(63.7)
No. of metastatic sites
0 or 1	116(64.8)
≥2	63(35.2)
Treatment modality
Chemoradiotherapy	120(67.0)
Chemotherapy or radiotherapy only	59(33.0)
Prophylactic cranial irradiation
Yes	72(40.2)
No	107(59.8)
Cycles of chemotherapy
< 4	75(41.9)
≥ 4	104(58.1)
Response
CR + PR	68(38.0)
SD + PD	111(62.0)
CEA(ng/mL)
Normal	83(46.4)
Elevated	96(53.6)
NSE(ng/mL)
Normal	78(43.6)
Elevated	101(56.4)
CYFRa21-1(ng/mL)
Normal	130(72.6)
Elevated	49(27.4)
Median OS time (month [95%CI])	15.0 (14.0–17.0)
Median PFS time (month [95%CI])	10.0 (8.0–12.0)

Abbreviations: KPS, Karnofsky performance score; LD, Limited disease; ED, Extensive disease; CR, complete response; PR, partial response; SD, Stable disease; PD, Progressive disease; CEA, carcinoembryonic antigen; NSE, neuron-specific enolase; CYFRA21-1, cytokeratin 19 fragments; OS, overall survival; PFS, progression-free survival; CI, confidence interval.

Table 2. The laboratory biomarkers.

Biomarkers	Median (95%CI)
CEA(ng/mL)	5.10(4.60–5.39)
NSE(ng/mL)	29.00(23.90–36.13)
CYFRa21-1(ng/mL)	2.68(2.53–2.86)
Serum albumin (mg/dL)	42.60(41.90–43.20)
Total cholesterol (mg/dL)	232(215–240)
Neutrophil	6.11(5.83–6.48)
Lymphocyte	1.84(1.70–1.93)
Monocyte	0.52 (0.51–0.58)
NLR	3.53(3.26-3.70)
LMR	3.32(2.87–3.67)

Abbreviations: CEA, carcinoembryonic antigen; NSE, neuron-specific enolase; CYFRA21-1, cytokeratin 19 fragments; NLR: Neutrophil-to-lymphocyte ratio; LMR: lymphocyte-to-monocyte ratio.

Figure 2. ROC Curve of NPS for recurrence prediction. Abbreviations: Receiver operating characteristic (ROC); Naples prognostic score (NPS).

Table 3. Relationship between NPS and clinicopathological characteristics.

Characteristics	Naples prognostic score			P-value
	Group 0 n%	Group 1 n%	Group 2 n%
Age (years)				0.178
<60	14(45.2%)	40(40.0%)	27(56.3%)
≥60	17(54.8%)	60(60.0%)	21(43.7%)
Sex				0.977
Male	17(54.8%)	56(56.0%)	26(54.2%)
Female	14(45.2%)	44(44.0%)	22(45.8%)
Smoking status				0. 726
No-smoker	19(61.3%)	65(65.0%)	28(58.3%)
Smoker	12(38.7%)	35(35.0%)	20(41.7%)
KPS				0.163
90-100	22(71.0%)	79(79.0%)	31(64.6%)
70-80	9(29.0%)	21(21.0%)	17(55.4%)
Disease extent				0.306
LS	15(48.4%)	34(34.0%)	16(33.3%)
ES	16(51.6%)	66(66.0%)	32(66.7%)
No. of metastatic sites				0.138
0 or 1	24(77.4%)	59(59.0%)	33(68.8%)
≥2	7(22.6%)	41(41.0%)	15(21.2%)
Treatment modality				<0.001
Chemoradiotherapy	21(67.7%)	81(81.0%)	18(37.5%)
Chemotherapy or radiotherapy only	10(32.3%)	19(19.0%)	30(62.5%)
Prophylactic cranial irradiation				0.400
Yes	15(48.4%)	41(41.0%)	16(33.3%)
No	16(51.2%)	59(59.0%)	32(66.7%)
Cycles of chemotherapy				0.383
<4	13(41.9%)	38(38.0%)	24(50.0%)
≥ 4	18(58.1%)	62(62.0%)	24(50.0%)
Response				0.337
CR + PR	13(41.9%)	41(41.0%)	14(29.2%)
SD + PD	18(58.1%)	59(59.0%)	34(70.8%)
Serum CEA(ng/mL)				0.03
Normal	21(67.7%)	43(43.0%)	19(39.6%)
High	10(22.3%)	57(57.0%)	29(60.4%)
NSE(ng/mL)				0.929
Normal	13(41.9%)	43(43.0%)	22(45.8%)
Elevated	18(58.1%)	57(58.0%)	26(54.2%)
CYFRa21-1(ng/mL)				0.309
Normal	20(64.5%)	77(77.0%)	33(68.8%)
Elevated	11(35.5%)	23(23.0%)	15(31.2%)

Abbreviations: KPS, Karnofsky performance score; LS, Limited-stage; ES, Extensive-stage; CR, complete response; PR, partial response; SD, Stable disease; PD, Progressive disease; LDH, lactic dehydrogenase; CEA, carcinoembryonic antigen; NSE, neuron-specific enolase; CYFRA21-1, cytokeratin 19 fragments.

Figure 3. Correlations between serum albumin, total cholesterol, NLR, and LMR. a serum albumin and total cholesterol. b serum albumin and NLR. c serum albumin and LMR. d total cholesterol and NLR. e total cholesterol and LMR. f NLR and LMR. Abbreviations: neutrophil to lymphocyte ratio (NLR), lymphocyte to monocyte ratio (LMR).

Figure 4. Kaplan-Meier survival curves of OS (A) and PFS (B) according to NPS group for all patients. Abbreviations: Overall survival (OS), Progression-free survival (PFS).

Figure 5. Kaplan-Meier survival curves of OS and PFS according to NPS group for LS-SCLC patients (A, OS; B, PFS) and ES-SCLC patients (C, OS; D, PFS). Abbreviations: Overall survival (OS), Progression-free survival (PFS).

Table 4. Univariate analysis about impact of variables on OS and PFS.

Variables	OS			PFS
	HR	95% CI	P-value	HR	95% CI	P-value
Age (years)			0.298			0.663
<60	Reference 1.218			Reference
≥60		0.840-1.767		1.091	0.738-1.613
Sex			0.932			0.998
Male	Reference 0.984			Reference
Female		0.681-1.423		1.001	0.675-1.483
Smoking status			0.588			0.437
No-smoker	Reference 0.901			Reference
Smoker		0.617-1.315		0.851	0.566-1.278
KPS			0.026			0.005
90-100	Reference 1.565			Reference
70-80		1.056-2.319		1.817	1.201-2.748
Disease extent			0.045			0.009
LS	Reference 1.546			Reference
ES		1.010-2.366		1.803	1.157-2.808
No. of metastatic sites			0.771			0.758
0 or 1	Reference 1.060			Reference
≥2		0.716-1.568		1.067	0.706-1.613
Treatment modality			0.762			0.924
Chemoradiotherapy	Reference 0.938			Reference
Chemotherapy or radiotherapy only		0.622-1.416		1.020	0.673-1.547
Prophylactic cranial irradiation			0.022			0.011
Yes	Reference 1.578			Reference
No		1.067-2.334		1.741	1.137-2.665
Cycles of chemotherapy			0.872			0.676
<4	Reference 1.031			Reference
≥ 4		0.713-1.491		1.088	0.733-1.615
Response			0.002			0.001
CR + PR	Reference			Reference
SD + PD	1.911	1.258-2.904		2.127	1.352-3.346
Serum CEA(ng/mL)			0.082			0.057
Normal	Reference 1.406			Reference
High		0.958-2.062		1.470	0.988-2.186
NSE(ng/mL)			0.577			0.786
Normal	Reference			Reference
Elevated	1.111	0.767-1.611		1.056	0.713-1.563
CYFRA21-1(ng/mL)			0.259			0.332
Normal	Reference			Reference
High	0.775	0.497-1.207		1.252	0.795-1.970
NPS Group
0	Reference			Reference
1	2.322	1.244-4.336	0.008	1.939	0.982-3.829	0.056
2	5.030	2.595-9.749	<0.001	3.633	1.808-7.303	<0.001

Abbreviations: OS, overall survival; PFS, progression-free survival; HR, hazard ratio; CI, confidence interval; KPS, Karnofsky performance score; LS, Limited-stage; ES, Extensive-stage; CR, complete response; PR, partial response; SD, Stable disease; PD, Progressive disease; LDH, lactic dehydrogenase; CEA, carcinoembryonic antigen; NSE, neuron-specific enolase; CYFRA21-1, cytokeratin 19 fragments.

Table 5. Multivariate analysis about impact of variables on OS and PFS.

Variables	OS			PFS
	HR	95% CI	P-value	HR	95% CI	P-value
KPS			0.241			0.087
90-100	Reference			Reference
70-80	1.305	0.836-2.036		1.468	0.946-2.280
Disease extent			0.122			0.041
LS	Reference			Reference
ES	1.405	0.913-2.163		1.603	1.020-2.520
Prophylactic cranial irradiation			0.136			0.242
Yes	Reference			Reference
No	1.373	0.905-2.084		1.314	0.832-2.075
Response			0.029			0.036
CR + PR	Reference			Reference
SD + PD	1.613	1.051-2.477		1.661	1.035-2.666
NPS Group
0	Reference			Reference
1	2.704	1.403-5.210	0.003	2.018	1.014-4.014	0.045
2	5.154	2.614-10.166	<0.001	3.339	1.650-6.756	0.001

Abbreviations: OS, overall survival; PFS, progression-free survival; HR, hazard ratio; CI, confidence interval; KPS, Karnofsky performance score; LS, Limited-stage; ES, Extensive-stage; CR, complete response; PR, partial response; SD, Stable disease; PD, Progressive disease.

Data availability statement

The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.