Clinical significance of the Naples prognostic score in predicting short- and long-term postoperative outcomes of patients with hepatocellular carcinoma

Background: The Naples prognostic score (NPS) is a remarkable marker of short- and long-term outcomes in various types of cancer. However, its impact on the postoperative outcomes of hepatocellular carcinoma remains controversial. This study aimed to clarify the impact of the NPS on the prognosis and incidence of postoperative complications in hepatocellular carcinoma.

Methods: Patients with hepatocellular carcinoma (n = 374) were categorized into high- and low-Naples prognostic score groups; their postoperative outcomes were compared. Prognostic and risk factors for severe postoperative complications were identified using multivariate analyses.

Results: The low-Naples prognostic score group had significantly longer overall and recurrence-free survivals than the high-Naples prognostic score group (p = 0.03 and 0.04, respectively). Subgroup analysis revealed a superior predictive value of the NPS in the group with a single tumor (p = 0.03), tumor diameter ≤5 cm (p = 0.04), and tumor stage I or II (p = 0.04). A high NPS was an independent prognostic factor for overall survival (hazard ratio, 1.45; 95% confidence interval (CI), 1.01-2.05; and p = 0.04). The NPS 2-4 group had a higher incidence of the Clavien-Dindo grade ≥ IIIa postoperative complications than the 0-1 group (p = 0.03) and a score of 2-4 was identified as an independent risk factor for the Clavien-Dindo grade ≥ IIIa postoperative complications (odds ratio, 2.06; 95% CI, 1.01-4.20; and p = 0.05).

Conclusions: The NPS effectively predicts postoperative outcomes in patients with hepatocellular carcinoma.