The Prognostic Role of the Naples Prognostic Score in Testicular Germ Cell Tumors: A Retrospective Analysis

To evaluate the prognostic significance of the Naples Prognostic Score (NPS) in patients with testicular germ cell tumors (TGCT), including its association with tumor stage, histological subtype, and survival outcomes. In this retrospective study, 133 patients with TGCT treated at a single tertiary center between 2015 and 2023 were evaluated. The NPS was calculated for each patient based on pre-treatment albumin, cholesterol, neutrophil-to-lymphocyte ratio (NLR), and lymphocyte-to-monocyte ratio (LMR). Patients were stratified into low (0-2) and high (3-4) NPS groups. Clinicopathological characteristics were compared between NPS groups. Overall survival was analyzed using Kaplan-Meier estimates with log-rank tests, and Cox proportional hazards regression was performed to identify independent prognostic factors. Patients with high NPS were significantly younger on average and more likely to have non-seminomatous histology, advanced clinical stage, elevated tumor markers, and metastatic disease compared to those with low NPS (all p < 0.01). Overall survival was markedly worse in the high NPS group (p < 0.005). On multivariate analysis, NPS emerged as an independent predictor of poorer overall survival alongside clinical stage (hazard ratio for high NPS ≈8.4, p = 0.018). The NPS is a significant prognostic indicator in TGCT. A high NPS is associated with aggressive disease features and inferior survival outcomes, remaining an independent prognostic factor when controlling for stage. Incorporating NPS into clinical risk stratification may help identify TGCT patients at higher risk of treatment failure, though prospective studies are warranted to validate its utility.