A Naples prognostic score-based nomogram enhances perioperative risk stratification for resected pancreatic cancer

The Naples Prognostic Score (NPS), integrating nutritional and inflammatory markers, may improve perioperative risk assessment in pancreatic ductal adenocarcinoma (PDAC). We evaluated the prognostic value of preoperative NPS in resected PDAC and developed an internally validated nomogram for overall survival. This retrospective single-center study included 349 patients who underwent curative-intent resection for PDAC between 2014 and 2020. Patients were randomly assigned to a training cohort (n = 174) and a validation cohort (n = 175). NPS was calculated using preoperative albumin, total cholesterol, neutrophil-to-lymphocyte ratio, and lymphocyte-to-monocyte ratio. Cox regression identified independent predictors of overall survival. A nomogram incorporating NPS, TNM stage, and adjuvant chemotherapy was developed and evaluated using the concordance index, time-dependent receiver operating characteristic curves, calibration, and decision curve analysis. Preoperative NPS remained an independent predictor of survival in both cohorts. Compared with TNM stage alone, the nomogram demonstrated better discrimination, with higher C-index and area under the curve values at 1, 2, and 3 years. Calibration and decision curve analyses suggested good agreement and potential clinical benefit. Preoperative NPS may complement conventional staging after PDAC resection. This NPS-based nomogram improved prognostic stratification, but external multicenter validation is required before routine clinical application. People who have surgery for pancreatic cancer can have different outcomes. Doctors need simple ways to see who may need closer care. We studied 349 people who had pancreatic cancer surgery at one hospital. Before surgery, we used routine blood tests to make a score called the Naples Prognostic Score. The score includes blood protein, blood fat, and white blood cell counts. People with a higher score tended to live for a shorter time. We then made a simple chart that also used cancer stage and whether the person received chemotherapy after surgery. In this study, the chart estimated survival at 1, 2, and 3 years better than cancer stage alone. The chart is not ready to guide care by itself. It should be tested in more hospitals first.