Prognostic Power of the Naples Score in Non-Small Cell Lung Cancer: Can Inflammation and Nutrition Predict Survival?

Abstract Aim: This study aimed to investigate the prognostic value of the Naples Prognostic Score (NPS), a composite index of inflammation and nutrition markers, in patients with non-small cell lung cancer (NSCLC), and to assess its role in predicting survival across clinical subgroups. Materials and Methods: A retrospective analysis was conducted on 250 patients diagnosed with NSCLC between 2018 and 2023. Patients were categorized into low (≤2) and high (>2) NPS groups based on the scoring system derived from neutrophil-lymphocyte ratio (NLR), lymphocyte-monocyte ratio (LMR), serum albumin, and total cholesterol levels. Survival outcomes were analyzed using Kaplan-Meier curves, log-rank tests, and univariate and multivariate Cox regression analyses. Receiver operating characteristic (ROC) analysis was performed to determine the discriminatory ability of NPS. Results: Patients with high NPS (>2) had significantly lower overall survival (median OS: 10.4 vs. 18.2 months, p< 0.001) and progression-free survival (median PFS: 7.3 vs. 12.5 months, p< 0.001) than those with low NPS. High NPS was found to be an independent prognostic factor in multivariate Cox regression analysis (HR: 1.98, 95% CI: 1.42–2.76, p< 0.001). ROC analysis showed an AUC of 0.78 for NPS in predicting survival. Subgroup analyses demonstrated the consistent prognostic impact of high NPS across histological subtypes, TNM stages, smoking status, albumin levels, and age groups. Conclusion: NPS is an independent and practical prognostic tool in NSCLC. Its use may enhance risk stratification and support personalized treatment planning, particularly in advanced-stage patients.