Naples Prognostic Score is an Independent Prognostic Factor in Patients with Small Cell Lung Cancer and Nomogram Predictive Model Established

Figures & data

Table 1 The Grading Standard of NPS

Grade (Points)	ALB (g/dL)	TC (mg/dL)	NLR	LMR
0	≥4	>180	≤2.96	>4.44
1	<4	≤180	>2.96	≤4.44

Abbreviations: ALB, albumin; TC, total cholesterol; NLR, neutrophil- lymphocyte ratio; LMR, lymphocyte- monocyte ratio.

Table 2 Clinical Characteristics of Patients

	Baseline	No.
Gender	Male	97(75.8%)
	Female	31(24.2%)
Age	<65years	60(46.9)
	≥65years	68(53.1%)
Smoking	Yes	78(60.9%)
	No	50(39.1%)
Staging	Limited stage	51(39.8%)
	Extensive stage	77(60.2%)
BMI	<25	75(58.6%)
	≥25	53(41.4%)
PS	1	81(63.3%)
	2	47(36.7%)
CCI	0	61(47.7%)
	1–2	64(50.0%)
	≥3	3(2.3%)
Surgery	Yes	35(27.3%)
	No	93(72.7%)
LDH	<208.35	86(67.2%)
	≥208.35	42(32.8%)
ALB	≥4 g/dL	65(50.8%)
	<4 g/dL	63(49.2%)
TC	>180mg/dL	55(43.0%)
	≤180mg/dL	73(57.0%)
LMR	>4.44	63(49.2%)
	≤4.44	65(50.8%)
NLR	<2.96	79(61.7%)
	≥2.96	49(38.3%)
SII	<874.43	80(62.5%)
	≥874.43	48(37.5%)
PLR	<281.90	111(86.7%)
	≥281.90	17(13.3%)
PNI	<40	11(8.6%)
	≥40	117(91.4%)
Chemotherapy	Yes	86(67.2%)
	No	42(32.8%)
Radiotherapy	Yes	43(33.6%)
	No	85(66.4%)
CEA	Normal	108(84.4%)
	High	20(15.6%)
NSE	Normal	61(47.7%)
	High	67(52.3%)

Abbreviations: BMI, Body Mass Index; PS, performance status; CCI, Charlson comorbidity index; LDH, lactate dehydrogenase; ALB, serum albumin; TC, total cholesterol; LMR, lymphocyte/monocyte ratio; NLR, neutrophil/lymphocyte ratio; SII, systemic immune‐inflammation index; PLR, platelet/lymphocyte ratio; PNI, Prognostic Nutrition Index; CEA, carcinoembryonic antigen; NSE, neuron-specific enolase.

Figure 1 ROC curves of LDH, SII, PLR, CEA, and NSE cutoff values were determined.

Table 3 Relationship Between Patient Characteristics and NPS Grade

	Baseline	Group 0	Group 1	Group 2	P value
		N=11	N=75	N=42
Gender	Male	5(5.2%)	57(58.8%)	35(36.1%)	0.033
	Female	6(19.4%)	18(58.1%)	7(22.6%)
Age	<65years	9(15.0%)	39(65.0%)	12(20.0%)	0.003
	≥65years	2(2.9%)	36(52.9%)	30(44.1%)
Smoking	Yes	4(5.1%)	46(59.0%)	28(35.9%)	0.185
	No	7(14.0%)	29(58.0%)	14(28.0%)
Staging	Limited stage	7(13.7%)	38(74.5%)	6(11.8%)	0.000
	Extensive stage	4(5.2%)	37(48.1%)	36(46.8%)
BMI	<25	3(4.0%)	42(56.0%)	30(40.0%)	0.023
	≥25	8(15.1%)	33(62.3%)	12(22.6%)
PS	1	11(13.6%)	50(61.7%)	20(24.7%)	0.004
	2	0(0.0%)	25(53.2%)	22(46.8%)
CCI	0	8(13.1%)	35(57.4%)	18(29.5%)	0.337
	1–2	3(4.7%)	39(60.9%)	22(34.4%)
	≥3	0(0.0%)	1(33.3%)	2(66.7%)
Surgery	Yes	5(14.3%)	28(80.0%)	2(5.7%)	0.000
	No	6(6.5%)	47(50.5%)	40(43.0%)
LDH	<208.35	11(12.8%)	51(59.3%)	24(27.9%)	0.026
	≥208.35	0(0.0%)	24(57.1%)	18(42.9%)
ALB	≥4 g/dL	11(16.9%)	51(78.5%)	3(4.6%)	0.000
	<4 g/dL	0(0.0%)	24(38.1%)	39(61.9%)
TC	>180mg/dL	11(20.0%)	38(69.1%)	6(10.9%)	0.000
	≤180mg/dL	0(0.0%)	37(50.7%)	36(49.3%)
LMR	>4.44	11(17.5%)	45(71.4%)	7(11.1%)	0.000
	≤4.44	0(0.0%)	30(46.2%)	35(53.8%)
NLR	<2.96	11(13.9%)	53(67.1%)	15(19.0%)	0.000
	≥2.96	0(0.0%)	22(44.9%)	27(55.1%)
SII	<874.43	10(12.5%)	52(65.0%)	18(22.5%)	0.002
	≥874.43	1(2.1%)	23(47.9%)	24(50%)
PLR	<281.90	10(9.0%)	67(60.4%)	34(30.6%)	0.401
	≥281.90	1(5.9%)	8(47.1%)	8(47.1%)
PNI	<40	0(0.0%)	1(9.1%)	10(90.9%)	0.000
	≥40	11(9.4%)	74(63.2%)	32(27.4%)
Chemotherapy	Yes	9(10.5%)	53(61.6%)	24(27.9%)	0.182
	No	2(4.8%)	22(52.4%)	18(42.9%)
Radiotherapy	Yes	7(16.3%)	26(60.5%)	10(23.3%)	0.043
	No	4(4.7%)	49(57.6%)	32(37.6%)
CEA	Normal	11(10.2%)	67(62.0%)	30(27.8%)	0.012
	High	0(0.0%)	8(40.0%)	12(60.0%)
NSE	Normal	7(11.5%)	41(67.2%)	13(21.3%)	0.026
	High	4(6.0%)	34(50.7%)	29(43.3%)

Abbreviation: PNI, Prognostic Nutrition Index.

Table 4 Univariate and Multivariate Analysis for PFS

	Univariable Analysis				Multivariable Analysis
	P value	HR	95% CI		P value	HR	95% CI
			LL	UL			LL	UL
Gender	0.065	0.582	0.324	1.043
Age	0.008	1.842	1.164	2.914	0.772	0.929	0.562	1.534
Smoking	0.032	1.665	1.041	2.662	0.092	1.536	0.933	2.530
Staging	0.000	3.205	1.920	5.350	0.918	0.961	0.444	2.078
BMI	0.035	0.612	0.385	0.971	0.341	0.769	0.448	1.320
PS	0.031	1.626	1.040	2.541	0.818	0.941	0.562	1.577
CCI	0.856
	0.739	1.402	0.192	10.237
	0.672	1.536	0.211	11.193
Surgery	0.000	0.286	0.156	0.526	0.160	0.519	0.207	1.297
LDH	0.000	2.630	1.681	4.115	0.171	1.478	0.845	2.585
SII	0.013	1.759	1.121	2.761	0.958	0.985	0.568	1.710
PLR	0.000	3.162	1.762	5.675	0.240	1.661	0.712	3.877
Chemotherapy	0.023	0.586	0.367	0.935	0.453	0.780	0.408	1.492
Radiotherapy	0.781	0.937	0.593	1.481
CEA	0.001	2.473	1.403	4.358	0.153	1.623	0.835	3.157
NSE	0.000	3.618	2.185	5.990	0.103	1.807	0.887	3.680
PNI	0.056	0.526	0.269	1.028
NPS	0.000				0.074
	0.001	0.095	0.022	0.400	0.048	0.213	0.046	0.987
	0.001	0.437	0.273	0.700	0.104	0.643	0.378	1.094

Abbreviation: NPS, Naples prognostic score.

Figure 2 (A) Maier curves of PFS for each NPS group. (B) Maier curves of OS for each NPS group.

Table 5 Univariate and Multivariate Analysis for OS

	Univariable Analysis				Multivariable Analysis
	P value	HR	95% CI		P value	HR	95% CI
			LL	UL			LL	UL
Gender	0.083	0.602	0.337	1.076
Age	0.005	1.935	1.215	3.081	0.805	0.936	0.554	1.582
Smoking	0.011	1.848	1.142	2.991	0.027	1.785	1.069	2.979
Staging	0.000	3.341	2.033	5.491	0.972	0.986	0.461	2.112
BMI	0.027	0.593	0.372	0.946	0.258	0.739	0.437	1.248
PS	0.019	1.701	1.086	2.664	0.899	1.035	0.613	1.748
CCI	0.576
	0.641	1.605	0.219	11.738
	0.507	1.960	0.269	14.287
Surgery	0.000	0.270	0.147	0.496	0.127	0.490	0.196	1.226
LDH	0.000	2.502	1.597	3.922	0.246	1.405	0.791	2.494
SII	0.038	1.610	1.023	2.534	0.920	1.029	0.591	1.790
PLR	0.001	2.561	1.446	4.535	0.780	0.878	0.352	2.191
Chemotherapy	0.004	0.511	0.319	0.817	0.202	0.639	0.322	1.271
Radiotherapy	0.130	0.701	0.441	1.114
CEA	0.001	2.606	1.480	4.589	0.238	1.490	0.768	2.892
NSE	0.000	3.495	2.157	5.662	0.025	2.265	1.106	4.640
PNI	0.017	0.451	0.230	0.883	0.240	1.643	0.718	3.755
NPS	0.000				0.006
	0.002	0.44	0.006	0.327	0.018	0.079	0.010	0.648
	0.000	0.380	0.237	0.610	0.009	0.474	0.271	0.827

Figure 3 The 1-and 2-year nomogram predictive model for OS in SCLC patients.

Figure 4 ROC curves of the nomogram predictive model for the main queue.

Figure 5 (A) The calibration curves for predicting SCLC patients’ OS 1-year in the main queue. (B) The calibration curves for predicting SCLC patients’ OS 2-year in the main queue. (C) The calibration curves for predicting SCLC patients’ OS 1-year in the validation queue. (D) The calibration curves for predicting SCLC patients’ OS 2-year in the validation queue.