Naples Prognostic Score Predicts Tumor Regression Grade in Resectable Gastric Cancer Treated with Preoperative Chemotherapy

Abstract

Despite recent progresses, locally advanced gastric cancer remains a daunting challenge to embrace. Perioperative chemotherapy and D2-gastrectomy depict multimodal treatment of gastric cancer in Europe, shows better results than curative surgery alone in terms of downstaging, micrometastases elimination, and improved long-term survival. Unfortunately, preoperative chemotherapy is useless in about 50% of cases of non-responder patients, in which no effect is registered. Tumor regression grade (TRG) is directly related to chemotherapy effectiveness, but its understanding is achieved only after surgical operation; accordingly, preoperative chemotherapy is given indiscriminately. Conversely, Naples Prognostic Score (NPS), related to patient immune-nutritional status and easily obtained before taking any therapeutic decision, appeared an independent prognostic variable of TRG. NPS was calculated in 59 consecutive surgically treated gastric cancer patients after neoadjuvant FLOT4-based chemotherapy. 42.2% of positive responses were observed: all normal NPS and half mild/moderate NPS showed significant responses to chemotherapy with TRG 1–3; while only 20% of the worst NPS showed some related benefits. Evaluation of NPS in gastric cancer patients undergoing multimodal treatment may be useful both in selecting patients who will benefit from preoperative chemotherapy and for changing immune-nutritional conditions in order to improve patient’s reaction against the tumor.

Prognostic importance of the preoperative New‐Naples prognostic score for patients with gastric cancer

“…25 Although we have found some differences in the immune and nutritional status of CRC and GC patients. However, previous studies still show that the CRC-NPS can effectively predict the prognosis of GC, 10,[26][27][28][29] this indicates that CRC-NPS has good applicability. However, there may be some differences in the nutritional status of patients in different regions and different populations.…”

Assessment of Naples prognostic score in predicting survival for small cell lung cancer patients treated with chemoradiotherapy

“…Lieto et al. found that assessment of NPS in gastric cancer patients treating with multimodal treatment may be valuable in modulating immune-nutritional conditions in order to improve patient’s reaction against the tumor [ 50 ]. Therefore, NPS may represent different risk grades, suggesting that patients in different groups have different prognosis.…”

MalnutritiOn assessment with biOelectrical impedaNce analysis in gastRic cancer patIentS undergoing multimodaltrEatment (MOONRISE)—Study protocol for a single-arm multicenter cross-sectional longitudinal study

“…Of note, TRG is a better prognostic factor than the Response Evaluation Criteria in Solid Tumors (RECIST)–the most widely used tumor response classification [ 18 ]. In an Italian retrospective study, authors assessed the relation between immune-nutritional status and TRG among resectable GC patients [ 19 ]. Naples Prognostic Scale (NPS) was implemented to verify patient nutritional condition.…”