Naples prognostic score may predict overall survival in metastatic pancreatic cancer

Naples prognostic score (NPS) based on nutritional and inflammatory parameters can predict response to chemotherapy and overall survival (OS) in many cancer types. However, its significance in metastatic pancreatic cancer (PC) remains unclear. We evaluated the prognostic significance of the NPS in patients with metastatic PC receiving first line chemotherapy.

We retrospectively analyzed 215 patients with metastatic PC receiving first line FOLFIRINOX chemotherapy. NPS's were calculated using pre-chemotherapy laboratory data. Patients were divided into three groups according to their scores (NPS: 0; 1 & 2; 3 & 4 were grouped as 1, 2 and 3, respectively). The association of NPS with clinicopathological features and OS were evaluated.

Median age was 64 years, and median OS was 10.5 months. Hemoglobin levels were lower and Ca-19-9 values were higher with increasing NPS. Frequency of patients with bone and/or liver metastases, and with greater than 5 metastatic focus were higher in group 3. A lower NPS was associated with longer OS. The median OS in groups 1, 2, and 3 were 19.5, 12, and 8 months, respectively, and differed significantly. Univariate analysis revealed effect of NPS (3-4) on OS (HR: 2.38, 1.77-3.19). Other prognostic factors affecting OS were age, ECOG, liver, bone or lymph node metastases, number of metastatic foci (<5 vs >5), de-novo metastatic disease, and serum Ca-19-9 levels. NPS (3-4) was identified as an independent prognostic factor negatively affecting OS (HR: 1.89, 1.34-2.65) in multivariate analysis.

NPS may be a useful prognostic marker for the prediction of OS in metastatic PC patients receiving systemic chemotherapy.