Skip to main content
NCBI home page
In Vivo logoLink to In Vivo
. 2024 Mar 3;38(2):890–896. doi: 10.21873/invivo.13515

The Naples Prognostic Score Is an Independent Prognostic Factor for Gastric Cancer Patients Who Receive Curative Treatment

TORU AOYAMA 1,2,#, AYA KATO 1,#, ITARU HASHIMOTO 1, YUKIO MAEZAWA 1,2, KENTARO HARA 1,3, KEISUKE KAZAMA 1, KEISUKE KOMORI 1, HIROSHI TAMAGAWA 1, AYAKO TAMAGAWA 1, SHINSUKE NAGASAWA 1, HARUHIKO CHO 1,3, KENKI SEGAMI 1, MASATO NAKAZONO 1, KAZUKI OTANI 1, SHO SAWAZAKI 1, MASAKATSU NUMATA 1, NATSUMI KAMIYA 1, SUZUE YOSHIZAWA 1, SHINNOSUKE KAWAHARA 1, TAKASHI OSHIMA 1,3, AYA SAITO 1, NORIO YUKAWA 1, YASUSHI RINO 1
PMCID: PMC10905489  PMID: 38418121

Abstract

Background/Aim

This study aimed to evaluate the clinical impact of the Naples Prognostic Score (NPS) in patients with gastric cancer and to clarify the potential of the NPS as a nutritional and inflammation evaluation system.

Patients and Methods

This study included 158 patients who underwent curative treatment for gastric cancer between 2005 and 2020. The prognosis and clinical pathological parameters of the high-NPS (NPS >2) and low-NPS (NPS=0, 1) groups were analyzed.

Results

The overall survival (OS) rates at 3 and 5 years were 86.7% and 77.7%, respectively, in the low-NPS group and 55.4% and 47.4%, respectively, in the high-NPS group. There were significant differences in OS between the two groups. Uni- and multivariate analyses demonstrated that the NPS was an independent prognostic factor for OS (HR=2.495, 95%CI=1.240-5.451). In addition, the 3- and 5-year recurrence-free survival (RFS) rates were 82.1% and 76.0%, respectively, in the NPS-low group, and 43.8% and 36.6% in the NPS-high group. Univariate and multivariate analyses demonstrated that the NPS was an independent prognostic factor for RFS (HR=2.739, 95%CI=1.509-4.972). When the first site of recurrence was compared between the low-NPS group and high-NPS group, there were significant differences in peritoneal recurrence (8.7% vs. 34.3%, p=0.001) and hematologic recurrence (5.6% vs. 21.9%, p=0.004).

Conclusion

The NPS was a significant prognostic factor in patients with gastric cancer who received curative treatment. The NPS may be a promising biomarker for the treatment and management of gastric cancer.

Keywords: Naples Prognostic Score, gastric cancer, curative treatment, biomarker

Gastric cancer (GC) is the fifth most common cancer and the fourth leading cause of cancer-related death in the world (1,2). Gastrectomy with D2 lymphadenectomy and perioperative adjuvant treatment are standard treatments for locally advanced GC (3-5). Recently, the perioperative nutritional status and inflammation status have been shown to affect postoperative surgical complications, continuation of adjuvant treatment, and the occurrence of adverse events associated with adjuvant treatment (6-8). Furthermore, the perioperative nutritional status and inflammation status also affect long-term oncological outcomes (9,10). Currently, several scoring systems have been developed to evaluate the nutritional and perioperative inflammatory status, including the neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and albumin/C-reactive protein ratio (CAR) (11-13). While each score has a clinical impact on oncological outcomes there is no consensus on the optimal cutoff value for each score. Additionally, studies on the interaction between the nutritional status and inflammation scores have been limited.

The Naples Prognostic Score (NPS) was developed as a new scoring system for some malignancies (14-16). The NPS is calculated using serum albumin, serum cholesterol, NLR, and LMR and may therefore reflect host systemic inflammation and malnutrition. However, few studies have evaluated the clinical impact of the NPS in patients with gastric cancer.

The aim of the present study was to evaluate the clinical impact of the NPS in patients with gastric cancer and also clarify its potential application as a nutritional and inflammation evaluation system.

Patients and Methods

Patients. Consecutive patients who underwent curative resection for gastric cancer at Yokohama City University from 2005 to 2020 were selected based on medical records. The following inclusion criteria were applied: 1) histologically confirmed adenocarcinoma; 2) clinical stage I-III disease according to the 15th edition of the general rules of the Japanese Gastric Cancer Association for gastric cancer (17); 3) curative gastrectomy performed as primary treatment for gastric cancer; and 4) complete resection (R0 resection) of gastric cancer, including radical lymph node dissection.

Surgical procedure and adjuvant treatment. Each patient underwent gastrectomy with either D1+ or D2 nodal dissection. S-1-based adjuvant chemotherapy was administered for patients with pathological stage II or III disease (18,19).

Measurement of the NPS. The NPS was calculated based on the following four parameters: serum albumin (normal: ≥4 g/dl), total cholesterol (normal: >180 mg/dl), LMR (normal: ≤2.96), and NLR (normal: >4.44). The patients were divided into three groups. Patients with normal values for all four parameters were assigned a score of 0, those with one or two altered values were assigned to group 1, and those with three or four altered values were assigned to group 2 (20).

Follow-up. Follow-up examinations were conducted at outpatient clinics. The patients underwent hematological tests (including measurements of tumor markers) and physical examinations at least every three months for five years. Additionally, every three months during the first three years after surgery and every six months until five years after surgery, patients underwent computed tomography (CT) examinations.

Evaluations and statistical analyses. The chi-square test was used to assess the significance of the variances between the NPS and clinicopathological factors. Overall survival and recurrence-free survival curves were calculated using the Kaplan-Meier method. Univariate and multivariate survival analyses were performed using the Cox proportional hazards model. Statistical significance was set at p<0.05. All statistical analyses were conducted using SPSS (v27.0 J Win; IBM, Armonk, NY, USA). The present study was approved by the institutional review board of Yokohama City University.

Results

Patients background. The present study included 158 patients. The median age was 70 years (range=32-87 years). One hundred thirteen patients were male and 45 patients were female. Based on previous study results and 3- and 5-year survival rates, we divided patients into low-NPS (NPS=0 and 1) and high-NPS (NPS=2) groups. When comparing the patient backgrounds of the low- and high-NPS groups, there were significant differences in T status, lymph node metastasis status, and lymphovascular invasion status (Table I). The incidence of aggressive tumor status was significantly higher in the NPS-high group than in the NPS-low group.

Table I. Comparison of survival rates stratified by patient characteristics.

graphic file with name in_vivo-38-891-i0001.jpg

Open in a new tab

NPS: Naples prognostic score.

Survival analysis. In the present study, the 3- and 5-year overall survival rates were 86.7% and 77.7%, respectively, in the NPS-low group and 55.4% and 47.4% in the NPS-high group. Figure 1 shows the overall survival (OS) curves. There were significant differences in OS between the two groups. Univariate and multivariate analyses demonstrated that the NPS was an independent prognostic factor (HR=2.495, 95%CI=1.240-5.451) (Table II). In addition, the 3- and 5-year recurrence-free survival (RFS) rates were 82.1% and 76.0%, respectively, in the NPS-low group and 43.8% and 36.6% in the NPS-high group. Figure 2 shows the RFS curves. There were significant differences in RFS between the two groups. Univariate and multivariate analyses demonstrated that the NPS was an independent prognostic factor (HR=2.739, 95%CI=1.509-4.972) (Table III). When the first recurrence sites between the NPS-low and NPS-high groups were compared, there were significant differences in peritoneal recurrence (8.7% vs. 34.3%, p=0.001) and hematological recurrence (5.6% vs. 21.9%, p=0.004) (Table IV).

Figure 1. Overall survival in patients with gastric cancer in the high-Naples Prognostic Score (NPS) group and low-NPS group.

Figure 1

Open in a new tab

Table II. Uni and Multivariate Cox proportional hazards analysis of clinicopathological factors for overall survival.

graphic file with name in_vivo-38-893-i0001.jpg

Open in a new tab

Figure 2. Recurrence-free survival in patients with gastric cancer in the high-Naples Prognostic Score (NPS) group and low-NPS group.

Figure 2

Open in a new tab

Table III. Uni and Multivariate Cox proportional hazards analysis of clinicopathological factors for recurrence-free survival.

graphic file with name in_vivo-38-894-i0001.jpg

Open in a new tab

Table IV. Patterns of recurrence according to Naples Prognostic Score.

graphic file with name in_vivo-38-894-i0002.jpg

Open in a new tab

Perioperative clinical course in the NPS-low group and NPS-high group. When comparing the perioperative clinical course, the rates of perioperative complications were as follows: postoperative surgical complications (NPS-low vs. NPS-high: 34.1% vs. 43.8%; p=0.311), pneumonia (5.6% vs. 6.3%; p=0.880), anastomotic leakage (4.8% vs. 6.3%; p=0.732), abdominal abscess (4.0% vs. 3.1%; p=0.824), and pancreatic fistula (8.7% vs. 6.3%; p=0.648). There were no significant differences between the two groups.

With regard to the clinical course of postoperative adjuvant chemotherapy, the percentage of patients who required adjuvant chemotherapy in the NPS-low and NPS-high groups was 23.8% and 59.3%, respectively (p<0.001), while the percentage of patients who received adjuvant chemotherapy was 83.3% and 68.4% (p=0.223). The percentage of cases in which adjuvant chemotherapy was terminated due to adverse events was 37.5% in the NPS-low group and 30.0% in the NPS-high group (p=0.290).

Discussion

The aim of the present study was to clarify the clinical impact of the NPS as a prognostic factor for patients with gastric cancer who received curative treatment. The main finding was that the NPS was a significant prognostic factor. Additionally, the NPS affected recurrence patterns. Therefore, the NPS is a promising biomarker for the treatment and management of patients with gastric cancer.

In the present study, patients with higher NPS values had a poorer prognosis, and the hazard ratio of a higher NPS was 2.495 (95%CI=1.240-5.451). Similar results have been reported in previous studies.

Xiong et al. evaluated the clinical impact of the NPS in 1,283 patients with gastric cancer who underwent curative surgery (21). They reported that the NPS was associated with age, sex, body mass index, and tumor progression. The patients in the NPS-high group were older and showed a male predominance, lower body mass index, and aggressive tumor status. The median OS in the NPS 0, NPS 1, and NPS 2 groups was 67.7, 52.5, and 35.7 months, respectively. The NPS was closely related to OS. The univariate and multivariate analyses showed that the HR for OS was 2.21 (95%CI=1.27-3.31) for NPS 1 and 3.45 (95%CI=1.43-5.17) for NPS 2 in their study. They concluded that the NPS represents a simple and useful rating system that can independently predict the survival of patients with gastric cancer undergoing surgery. Xiong et al. evaluated the clinical impact of the NPS in 231 patients with adenocarcinomas of the esophagogastric junction who underwent curative surgery (22). The median OS and RFS was 60.0 and 56.4 months, respectively, in the NPS 0 group, 49.2 and 43.6 months in the NPS 1 group, and 43.6 and 32.4 months in NPS 2 group. The NPS score was closely related to OS and RFS. The univariate and multivariate analyses showed that the HR for OS was 1.85 (95%CI=1.22-2.43) for NPS 1 and 3.29 (95%CI=2.16-3.17) for NPS 2 in their study. They concluded that the NPS represents a simple and useful rating system that can independently predict the survival of patients with adenocarcinoma of the esophagogastric junction who undergo surgery.

There are several possible explanations as to why the NPS affects the survival of patients with gastric cancer. One possibility is that the NPS affects the response to chemotherapy. Lieto et al. evaluated the clinical relationship between the NPS and tumor regression grade in 59 patients with gastric cancer who received FLOT-4-based neoadjuvant chemotherapy and curative gastrectomy (23). They reported that total or partial tumor regression was observed in 100% of the patients in the NPS 0 group, 50% of the patients in the NPS 1 group, and 17.4% of the patients in the NPS 2 group. They concluded that evaluation of the NPS in patients with gastric cancer undergoing multimodal treatment may be useful both in selecting patients who will benefit from preoperative chemotherapy and for changing immuno-nutritional conditions in order to improve the patient’s reaction to the tumor. Although there was no relationship between the perioperative clinical course of adjuvant chemotherapy, such as the introduction of adjuvant chemotherapy, and the occurrence of adverse events from the adjuvant chemotherapy, in the present study, the NPS might have some clinical impact on the efficacy of perioperative adjuvant treatment. Therefore, future studies should focus on this issue. The second possible reason is that the NPS affects postoperative surgical complications. Although there was no relationship between the NPS and the occurrence of postoperative surgical complications in the present study, some reports suggest a clinical relationship between the NPS and postoperative surgical complications in gastrointestinal cancers. Lin et al. clarified the clinical relationship between the NPS and postoperative surgical complications in 2,182 patients with gastric cancer who underwent curative surgery (24). They found that the incidence of severe postoperative surgical complications was significantly higher in the high-NPS group (NPS >1) than in the low-NPS group (NPS ≤1) (3.7% vs. 1.8%, p=0.008). They concluded that the NPS is an important tool for assessing the risk of severe postoperative surgical complications. Galizia et al. evaluated the clinical relationship between the NPS and postoperative surgical complications in 468 patients with colorectal cancer who received curative treatment (20). The incidence of postoperative surgical complications increased with worsening NPS. The incidence of postoperative surgical complications was 8-10% in the NPS-low group and 14-21% in the NPS-high group. Considering this, NPS status might have some clinical impact on the occurrence of postoperative surgical complications in gastrointestinal cancer surgery.

To utilize the NPS in general practice, it is necessary to set an optimal cutoff value for each element. First, the NPS was proposed by Galizia et al. using patients with colorectal cancer and is composed of the preoperative LMR, NLR, serum albumin, and total cholesterol (20). These elements include the nutritional and inflammatory status. However, previous studies have suggested that there are some differences in the nutritional and immune statuses of patients with colorectal and gastric cancers. Therefore, future studies should reconstruct the New-NPS according to the nutritional status of patients with gastric cancer. Wang et al. evaluated the new-NPS as a prognostic factor in patients with gastric cancer (25). In that study, the cutoff values used were 2.37 for NLR, 3.10 for LMR, 4.25 for albumin, and 156.81 for total cholesterol. They demonstrated that the New-NPS constructed according to the nutritional and immune status of patients with gastric cancer has a certain applicable value and is worthy of clinical application. Further studies are needed to clarify the optimal cutoff value for each element.

Study limitations. First, it was a retrospective, single-center study. Therefore, there may have been a selection bias. Second, the present study patients were treated between 2005 and 2020. Therefore, there may be a time bias. The perioperative adjuvant treatment was changed from 2005 to 2020. Initially, surgery alone was the standard of care; S-1 adjuvant therapy was introduced in 2007, and S-1 and docetaxel adjuvant therapy for stage III gastric cancer was introduced in 2015. Therefore, a validation study is required.

In conclusion, we found that the NPS was a significant prognostic factor for patients with gastric cancer who received curative treatment. NPS may be a promising biomarker for the treatment and management of gastric cancer.

Conflicts of Interest

The Authors declare no conflicts of interest in association with the present study.

Authors’ Contributions

TA and AK contributed substantially to this concept and design. TA, IH, YM, MT, TM, KH, KK1 (Keisuke Kazama), KK2 (Keisuke Komori), MN, SK, IH, and HC contributed substantially to data acquisition, analysis, and interpretation. TA, MN, SS, MT, HT, AS, TA, KS, SY, NK, TO, NY, and YR were involved in drafting and critically revising the manuscript for important intellectual content. TA and AK approved the final version of the manuscript.

Acknowledgements

This study was supported by JSPS KAKENHI (Grant Number 21K08688). This study was supported in part by the nonprofit organization of the Yokoyama Surgical Research Group (YSRG).

References

  • 1.Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394–424. doi: 10.3322/caac.21492. [DOI] [PubMed] [Google Scholar]
  • 2.Ferlay J, Colombet M, Soerjomataram I, Parkin DM, Piñeros M, Znaor A, Bray F. Cancer statistics for the year 2020: An overview. Int J Cancer. 2021;149(4):778–789. doi: 10.1002/ijc.33588. [DOI] [PubMed] [Google Scholar]
  • 3.Lordick F, Carneiro F, Cascinu S, Fleitas T, Haustermans K, Piessen G, Vogel A, Smyth EC, ESMO Guidelines Committee Gastric cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol. 2022;33(10):1005–1020. doi: 10.1016/j.annonc.2022.07.004. [DOI] [PubMed] [Google Scholar]
  • 4.Ajani JA, D’Amico TA, Bentrem DJ, Chao J, Cooke D, Corvera C, Das P, Enzinger PC, Enzler T, Fanta P, Farjah F, Gerdes H, Gibson MK, Hochwald S, Hofstetter WL, Ilson DH, Keswani RN, Kim S, Kleinberg LR, Klempner SJ, Lacy J, Ly QP, Matkowskyj KA, McNamara M, Mulcahy MF, Outlaw D, Park H, Perry KA, Pimiento J, Poultsides GA, Reznik S, Roses RE, Strong VE, Su S, Wang HL, Wiesner G, Willett CG, Yakoub D, Yoon H, McMillian N, Pluchino LA. Gastric Cancer, Version 2.2022, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2022;20(2):167–192. doi: 10.6004/jnccn.2022.0008. [DOI] [PubMed] [Google Scholar]
  • 5.Japanese Gastric Cancer Association Japanese Gastric Cancer Treatment Guidelines 2021 (6th edition) Gastric Cancer. 2023;26(1):1–25. doi: 10.1007/s10120-022-01331-8. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 6.Aoyama T. Perioperative body composition changes in the multimodal treatment of gastrointestinal cancer. Surg Today. 2020;50(3):217–222. doi: 10.1007/s00595-019-01815-8. [DOI] [PubMed] [Google Scholar]
  • 7.Aoyama T, Yoshikawa T, Shirai J, Hayashi T, Yamada T, Tsuchida K, Hasegawa S, Cho H, Yukawa N, Oshima T, Rino Y, Masuda M, Tsuburaya A. Body weight loss after surgery is an independent risk factor for continuation of S-1 adjuvant chemotherapy for gastric cancer. Ann Surg Oncol. 2013;20(6):2000–2006. doi: 10.1245/s10434-012-2776-6. [DOI] [PubMed] [Google Scholar]
  • 8.Aoyama T, Kawabe T, Fujikawa H, Hayashi T, Yamada T, Tsuchida K, Yukawa N, Oshima T, Rino Y, Masuda M, Ogata T, Cho H, Yoshikawa T. Loss of lean body mass as an independent risk factor for continuation of S-1 adjuvant chemotherapy for gastric cancer. Ann Surg Oncol. 2015;22(8):2560–2566. doi: 10.1245/s10434-014-4296-z. [DOI] [PubMed] [Google Scholar]
  • 9.Aoyama T, Sato T, Maezawa Y, Kano K, Hayashi T, Yamada T, Yukawa N, Oshima T, Rino Y, Masuda M, Ogata T, Cho H, Yoshikawa T. Postoperative weight loss leads to poor survival through poor S-1 efficacy in patients with stage II/III gastric cancer. Int J Clin Oncol. 2017;22(3):476–483. doi: 10.1007/s10147-017-1089-y. [DOI] [PubMed] [Google Scholar]
  • 10.Aoyama T, Yoshikawa T, Maezawa Y, Kano K, Numata M, Hara K, Komori K, Yamada T, Hayashi T, Sato T, Tamagawa H, Yukawa N, Rino Y, Masuda M, Ogata T, Cho H, Oshima T. The postoperative lean body mass loss at one month leads to a poor survival in patients with locally advanced gastric cancer. J Cancer. 2019;10(11):2450–2456. doi: 10.7150/jca.30697. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 11.Aoyama T, Hara K, Kazama K, Maezawa Y. Clinical impact of nutrition and inflammation assessment tools in gastric cancer treatment. Anticancer Res. 2022;42(11):5167–5180. doi: 10.21873/anticanres.16023. [DOI] [PubMed] [Google Scholar]
  • 12.Aoyama T, Kazama K, Maezawa Y, Hara K. Usefulness of nutrition and inflammation assessment tools in esophageal cancer treatment. In Vivo. 2023;37(1):22–35. doi: 10.21873/invivo.13051. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 13.Aoyama T, Maezawa Y, Hashimoto I, Rino Y, Oshima T. Clinical impact of nutrition and inflammation assessment tools in pancreatic cancer treatment. Anticancer Res. 2023;43(9):3849–3860. doi: 10.21873/anticanres.16572. [DOI] [PubMed] [Google Scholar]
  • 14.Nakagawa N, Yamada S, Sonohara F, Takami H, Hayashi M, Kanda M, Kobayashi D, Tanaka C, Nakayama G, Koike M, Fujiwara M, Kodera Y. Clinical implications of naples prognostic score in patients with resected pancreatic cancer. Ann Surg Oncol. 2020;27(3):887–895. doi: 10.1245/s10434-019-08047-7. [DOI] [PubMed] [Google Scholar]
  • 15.Peng SM, Ren JJ, Yu N, Xu JY, Chen GC, Li X, Li DP, Yang J, Li ZN, Zhang YS, Qin LQ. The prognostic value of the Naples prognostic score for patients with non-small-cell lung cancer. Sci Rep. 2022;12(1):5782. doi: 10.1038/s41598-022-09888-1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 16.Chen Y, Guan Z, Shen G. Naples prognostic score: a novel predictor of survival in patients with HER2-positive breast cancer. Future Oncol. 2022;18(21):2655–2665. doi: 10.2217/fon-2022-0212. [DOI] [PubMed] [Google Scholar]
  • 17.Japanese Gastric Cancer Association Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer. 2011;14(2):101–112. doi: 10.1007/s10120-011-0041-5. [DOI] [PubMed] [Google Scholar]
  • 18.Sakuramoto S, Sasako M, Yamaguchi T, Kinoshita T, Fujii M, Nashimoto A, Furukawa H, Nakajima T, Ohashi Y, Imamura H, Higashino M, Yamamura Y, Kurita A, Arai K, ACTS-GC Group Adjuvant chemotherapy for gastric cancer with S-1, an oral fluoropyrimidine. N Engl J Med. 2007;357(18):1810–1820. doi: 10.1056/NEJMoa072252. [DOI] [PubMed] [Google Scholar]
  • 19.Yoshida K, Kodera Y, Kochi M, Ichikawa W, Kakeji Y, Sano T, Nagao N, Takahashi M, Takagane A, Watanabe T, Kaji M, Okitsu H, Nomura T, Matsui T, Yoshikawa T, Matsuyama J, Yamada M, Ito S, Takeuchi M, Fujii M. Addition of docetaxel to oral fluoropyrimidine improves efficacy in patients with stage III gastric cancer: interim analysis of JACCRO GC-07, a randomized controlled trial. J Clin Oncol. 2019;37(15):1296–1304. doi: 10.1200/JCO.18.01138. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 20.Galizia G, Lieto E, Auricchio A, Cardella F, Mabilia A, Podzemny V, Castellano P, Orditura M, Napolitano V. Naples prognostic score, based on nutritional and inflammatory status, is an independent predictor of long-term outcome in patients undergoing surgery for colorectal cancer. Dis Colon Rectum. 2017;60(12):1273–1284. doi: 10.1097/DCR.0000000000000961. [DOI] [PubMed] [Google Scholar]
  • 21.Xiong J, Hu H, Kang W, Liu H, Ma F, Ma S, Li Y, Jin P, Tian Y. Prognostic impact of preoperative naples prognostic score in gastric cancer patients undergoing surgery. Front Surg. 2021;8:617744. doi: 10.3389/fsurg.2021.617744. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 22.Xiong J, Wang Y, Kang W, Ma F, Liu H, Ma S, Li Y, Jin P, Hu H, Tian Y. Prognostic importance of the preoperative naples prognostic score for patients with adenocarcinoma of the esophagogastric junction. Front Oncol. 2020;10:595793. doi: 10.3389/fonc.2020.595793. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 23.Lieto E, Auricchio A, Tirino G, Pompella L, Panarese I, Del Sorbo G, Ferraraccio F, De Vita F, Galizia G, Cardella F. Naples prognostic score predicts tumor regression grade in resectable gastric cancer treated with preoperative chemotherapy. Cancers (Basel) 2021;13(18):4676. doi: 10.3390/cancers13184676. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 24.Lin JX, Lin LZ, Tang YH, Wang JB, Lu J, Chen QY, Cao LL, Lin M, Tu RH, Huang CM, Li P, Zheng CH, Xie JW. Which nutritional scoring system is more suitable for evaluating the short- or long-term prognosis of patients with gastric cancer who underwent radical gastrectomy. J Gastrointest Surg. 2020;24(9):1969–1977. doi: 10.1007/s11605-019-04360-4. [DOI] [PubMed] [Google Scholar]
  • 25.Wang H, Fang T, Yin X, Lou S, Han B, Gao J, Wang Y, Wang X, Zhang D, Wang Y, Zhang Y, Xue Y. Prognostic importance of the preoperative New-Naples prognostic score for patients with gastric cancer. Cancer Med. 2023;12(2):1358–1375. doi: 10.1002/cam4.5017. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from In Vivo are provided here courtesy of International Institute of Anticancer Research

RESOURCES