The clinical significance of the modified Naples prognostic score for prostate cancer: a population-based study

The Naples Prognostic Score (NPS) is a widely recognized scoring system used to assess inflammation and nutrition status, yet its role in prostate cancer (PCa) remains unclear. This study aims to investigate the association between the modified NPS (MNPS) and PCa prevalence and mortality outcomes among participants with self-reported PCa.

Data from the National Health and Nutrition Examination Survey 1999-2018 were collected. The NPS was calculated using MaxStat analysis, while M1NPS and M2NPS were constructed with X-Tile analysis. Weighted logistic regression was used to estimate the odds ratio (OR) for PCa prevalence. Kaplan-Meier survival analysis, log-rank tests, and Cox proportional hazard ratios (HR) were employed to analyze the mortality risk.

Among 22,027 individuals, 717 had PCa. After considering the interactions among different factors and adjusting for confounding variables, the prevalence of PCa was notably higher in participants with the highest MNPS groups (group 3) compared with those with the lowest groups (group 1) (OR (95% CI) = 2.96 (1.57-5.57) for M1NPS; 15.50 (1.78-134.71) for M2NPS). With a median follow-up of 9.92 years, 326 (45.47%) of all-cause deaths occurred among participants with self-reported PCa. Significant differences in all-cause mortality were observed between the MNPS groups (log-rank P < 0.001 for M1NPS and M2NPS). Compared to participants with self-reported PCa in group 1, the adjusted HRs for all-cause mortality in group 3 were 1.12 (95% CI: 0.49-2.57) for M1NPS and 2.02 (95% CI: 1.19-3.44) for M2NPS. Furthermore, a significant association was found between M2NPS and cardiovascular mortality (HR (95% CI) = 4.77 (1.95-11.65).

The modified and optimized NPS, which integrates inflammation and nutritional status, is associated with PCa prevalence and with all-cause and cardiovascular mortality among individuals with self-reported PCa.