Predictive role of Naples prognostic score for survival in esophageal cancer: A meta-analysis

Background: To further clarify the predictive value of pretreatment Naples prognostic score (NPS), calculating based on the serum albumin concentration, total cholesterol level, neutrophil to lymphocyte ratio (NLR) and lymphocyte-to-monocyte ratio (LMR), among esophageal cancer patients based on available evidence. Methods: The PubMed, EMBASE, Web of Science and CNKI databases were searched up to December 1, 2023 for relevant studies. Overall survival (OS), progression-free survival (PFS) and cancer-specific survival (CSS) were endpoints and the hazard ratio (HR) with 95% confidence interval (CI) was combined to evaluate the predictive role of NPS for survival. Subgroup analysis based on pathological type and treatment were further conducted. Results: Ten retrospective studies with 2250 cases were included in our analysis. Pooled results demonstrated that higher pretreatment NPS predicted poorer OS (HR = 2.24, 95% CI: 1.57-3.20, P < .001), PFS (HR = 3.03, 95% CI: 1.84-4.98, P < .001) and CSS (HR = 2.90, 95% CI: 1.80-4.68, P < .001). Then subgroup analysis for the OS and PFS stratified by the pathological type (squamous cell carcinoma vs esophageal cancer) and treatment (surgery vs non-surgery) were further conducted, which showed similar results. Conclusion: Pretreatment NPS is significantly associated with prognosis in esophageal cancer and higher NPS predicts worse survival among patients with esophageal cancer.