The Significance Of Naples Prognostic Score In Ampullary Carcinoma Patients Undergoing Surgical Resection

Background: it is important for patients with ampullary carcinoma to determine a preoperative prognostic marker to help physicians determine whether some patients may benefit from surgery.Several preoperative factors have been shown to predict prognostic survival in patients with ampullary carcinoma.It is now widely recognized that the prognosis of cancer patients depends not only on certain features of the tumor;And certain host-related factors also play an important role.The Naples Prognostic Score is an effective tool to evaluate the nutritional and immunological status of patients with malignant tumor.Objective: The purpose of this study was to investigate the clinical significance of Naples Prognostic Score in preoperative survival of ampullary carcinoma after pancreaticoduodenectomy.Methods: 404 patients with ampullary carcinoma who received pancreaticoduodenectomy from Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology from January 2012 to June 2018 were retrospectively analyzed.Collected the basic information of the patients,preoperative examination of the data,the indicators of patients in the perioperative and postoperative patients recovery and pathology reports,information is not complete,with neoadjuvant therapy before surgery have nutrition intervention and immune therapy intervention prior to admission,and tumor classification is unclear,or other unknown factors of patients were excluded from the study.The Naples Prognostic Score was calculated by serum albumin,total cholesterol concentration,neutrophil-lymphocyte ratio(NLR),and lymphocyte-monocyte ratio(LMR).According to patients’ basic information,preoperative examination data,intraoperative patient indicators,and postoperative patient recovery and pathology reports,the Naples Prognostic Score system calculated for patients was divided into three groups.Variables of clinicopathological characteristics,preoperative and postoperative outcomes,and postoperative survival were compared between the three groups.The overall survival rate(OS)of patients with ampullary carcinoma and the survival rate(RFS)of patients without recurrence of ampullary carcinoma after surgery were analyzed by univariate and multivariate Cox regression.A time-dependent receiver operating characteristic curve and the differential ability of the prognostic scoring system were also created.Results: Patients with slightly lower Naples Prognostic Score had better quality of life,while patients with slightly higher Naples Prognostic Score had worse quality of life,and there were significant differences in overall survival(OS)and relapse-free survival(RFS)among different groups.Of the 404 patients,85 were assigned to group0(NPS 0),195 to group 1(NPS 1 or 2),and 124 to group 2(NPS 3 or 4).There were no significant differences in age,sex,ASA grade,body mass index(BM),CEA concentration,and other diseases among the three groups.NPS scores were significantly higher in patients with elevated levels of bilirubin,CA19-9 and CA125 after preoperative biliary drainage.At the same time,there were no differences among the three groups in T stage,peripheral nerve invasion,lymph node metastasis,tumor size and positive surgical site margin,etc.,but there were differences in tumor tissue type,vascular invasion,TNM stage,tumor grade and adjuvant therapy.Median overall survival time was 94.6 months in group 0,89.6 months in group 1,and 24.2months in group 2,respectively.Overall survival rate in group 0 vs.group 1,P=0.02;Group 1 vs.group 2,P<0.001;Group 0 vs.Group 2,P<0.001.The median recurrence-free survival time was 81.2 months in group 0,73.0 months in group 1 and20.5 months in group 2,respectively.Relapse-free survival rate in group 0 vs.group 1,P=0.088;Group 1 vs.group 2,P<0.001;Group 0 vs.Group 2,P<0.001.Multivariate analysis showed that the Naples Prognostic Score was an independent significant predictor of overall survival and non-response rates.Postoperative global complications were also independent risk factors for the Naples Prognostic Score,and the percentage of postoperative complications was significantly different among the three groups.Conclusions: The overall survival rate and relapsed-free survival rate after pancreaticoduodenectomy for ampullary carcinoma are independent factors of the Naples Prognostic Score,and the Naples Prognostic Score is closely related to the incidence of postoperative complications in patients with ampullary carcinoma.