Prognostic Role of the Naples Score in Extensive-Stage Small Cell Lung Cancer: A Missed Opportunity in Inflammation-Based Stratification
Abstract
1. Introduction
2. Materials and Methods
2.1. Study Design and Patient Selection
2.2. Data Collection and Laboratory Measurements
2.3. Naples Prognostic Score Assessment
2.4. Outcome Definition
2.5. Statistical Analysis
3. Results
3.1. Baseline Characteristics
3.2. Comparison Between Risk Groups
3.3. Overall Survival Analysis
3.4. Univariate Cox Regression Analysis
3.5. Multivariate Cox Regression Analysis
3.5.1. Model 1—Prognostic Impact of the Composite NPS
3.5.2. Model 2—Prognostic Role of Individual NPS Components
3.6. Exploratory Analysis Based on the Original NPS Classification
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
SCLC | Small Cell Lung Cancer |
ES-SCLC | Extensive-Stage Small Cell Lung Cancer |
NSCLC | Non-Small Cell Lung Cancer |
NPS | Naples Prognostic Score |
OS | Overall Survival |
PFS | Progression-Free Survival |
NLR | Neutrophil-to-Lymphocyte Ratio |
LMR | Lymphocyte-to-Monocyte Ratio |
ECOG PS | Eastern Cooperative Oncology Group performance status |
PCI | Prophylactic Cranial Irradiation |
TME | Tumor Microenvironment |
MMP | Matrix Metalloproteinase |
TAM | Tumor-Associated Macrophages |
CI | Confidence Interval |
HR | Hazard Ratio |
IQR | Interquartile Range |
SPSS | Statistical Package for the Social Sciences |
ORCID | Open Researcher and Contributor ID |
SD | Standard Deviation |
MD | Medical Doctor |
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Clinical Variable | Category | Total (n, %) | Low-Risk Group | High-Risk Group | p-Value |
---|---|---|---|---|---|
Age | <65 years | 95 (66.9%) | 56 (70.0%) | 39 (62.9%) | 0.472 |
≥65 years | 47 (33.1%) | 24 (30.0%) | 23 (37.1%) | ||
ECOG PS | 0 | 91 (64.1%) | 58 (72.5%) | 33 (53.2%) | 0.018 |
≥1 | 51 (35.9%) | 22 (27.5%) | 29 (46.8%) | ||
Sex | Female | 11 (7.7%) | 5 (6.3%) | 6 (9.7%) | 0.449 |
Male | 131 (92.3%) | 75 (93.8%) | 56 (90.3%) | ||
Smoking Status | Non-current smoker | 34 (23.9%) | 17 (21.3%) | 17 (27.4%) | 0.393 |
Current smoker | 108 (76.1%) | 63 (78.8%) | 45 (72.6%) | ||
Comorbidity | Absent | 72 (50.7%) | 41 (51.2%) | 31 (50.0%) | 0.883 |
Present | 70 (49.3%) | 39 (48.8%) | 31 (50.0%) | ||
Stage at Diagnosis | Limited disease | 39 (27.5%) | 23 (28.7%) | 16 (25.8%) | 0.697 |
Extensive disease | 103 (72.5%) | 57 (71.3%) | 46 (74.2%) | ||
PCI | Not administered | 107 (75.4%) | 56 (70.0%) | 51 (82.3%) | 0.093 |
Administered | 35 (24.6%) | 24 (30.0%) | 11 (17.7%) | ||
Number of Metastatic Sites | Single site | 45 (31.7%) | 25 (31.3%) | 20 (32.3%) | 0.898 |
≥2 sites | 97 (68.3%) | 55 (68.8%) | 42 (67.7%) | ||
Brain Metastasis | Absent | 102 (71.8%) | 57 (71.3%) | 45 (72.6%) | 0.861 |
Present | 40 (28.2%) | 23 (28.7%) | 17 (27.4%) | ||
Bone Metastasis | Absent | 71 (50.0%) | 44 (55.0%) | 27 (43.5%) | 0.176 |
Present | 71 (50.0%) | 36 (45.0%) | 35 (56.5%) | ||
Liver Metastasis | Absent | 105 (73.9%) | 61 (76.3%) | 44 (71.0%) | 0.477 |
Present | 37 (26.1%) | 19 (23.8%) | 18 (29.0%) | ||
Lung Metastasis | Absent | 117 (82.4%) | 67 (83.8%) | 50 (80.6%) | 0.630 |
Present | 25 (17.6%) | 13 (16.3%) | 12 (19.4%) | ||
Adrenal Metastasis | Absent | 109 (76.8%) | 61 (76.3%) | 48 (77.4%) | 0.870 |
Present | 33 (23.2%) | 19 (23.8%) | 14 (22.6%) |
Clinical Variable | Category | HR (95% CI) | p-Value | Reference Category |
---|---|---|---|---|
Age | ≥65 years | 1.35 (0.94–1.92) | 0.101 | <65 years |
ECOG PS | ECOG ≥ 1 | 1.43 (1.01–2.03) | 0.047 | ECOG 0 |
Sex | Male | 0.98 (0.53–1.83) | 0.957 | Female |
Smoking Status | Current smoker | 1.05 (0.71–1.55) | 0.809 | Non-current smoker |
Comorbidity | Present | 1.26 (0.91–1.76) | 0.168 | Absent |
Stage at Diagnosis | De novo | 0.93 (0.65–1.34) | 0.681 | Relapsed |
PCI | Yes | 0.98 (0.67–1.45) | 0.935 | No PCI |
Number of Metastatic Sites | ≥2 sites | 1.59 (1.11–2.29) | 0.012 | Single site |
Brain Metastasis | Present | 1.38 (0.95–2.00) | 0.088 | Absent |
Bone Metastasis | Present | 1.41 (1.01–1.98) | 0.044 | Absent |
Liver Metastasis | Present | 1.08 (0.74–1.58) | 0.691 | Absent |
Lung Metastasis | Present | 1.52 (0.98–2.33) | 0.061 | Absent |
Adrenal Metastasis | Present | 0.97 (0.65–1.44) | 0.868 | Absent |
NLR | High (≥cutoff) | 1.34 (0.95–1.89) | 0.098 | Low (<cutoff) |
LMR | High (≥cutoff) | 1.62 (1.06–2.47) | 0.027 | Low (<cutoff) |
Serum Cholesterol | High (≥cutoff) | 0.86 (0.57–1.30) | 0.475 | Low (<cutoff) |
Serum Albumin | High (≥cutoff) | 1.44 (1.02–2.03) | 0.040 | Low (<cutoff) |
NPS | High (3–4) | 1.54 (1.10–2.15) | 0.013 | Low (0–2) |
Variable | HR (95% CI) | p-Value |
---|---|---|
High NPS (3–4) | 1.45 (1.02–2.06) | 0.041 |
Bone metastasis | 1.27 (0.88–1.82) | 0.203 |
Brain metastasis | 1.23 (0.84–1.78) | 0.290 |
Lung metastasis | 0.68 (0.43–1.08) | 0.100 |
ECOG PS ≥ 1 | 1.19 (0.82–1.73) | 0.367 |
Age ≥ 65 | 1.20 (0.83–1.73) | 0.329 |
Variable | HR (95% CI) | p-Value |
---|---|---|
LMR (High) | 1.65 (1.04–2.61) | 0.034 |
Serum albumin (High) | 1.48 (1.03–2.11) | 0.033 |
NLR (High) | 1.01 (0.69–1.49) | 0.954 |
Bone metastasis | 1.30 (0.89–1.88) | 0.164 |
Brain metastasis | 1.18 (0.80–1.73) | 0.408 |
Lung metastasis | 0.71 (0.45–1.12) | 0.139 |
ECOG PS ≥ 1 | 1.43 (0.97–2.11) | 0.068 |
Age ≥ 65 | 1.11 (0.77–1.60) | 0.591 |
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Akgül, F.; Gökmen, İ.; Bayrakçı, İ.; Divriklioğlu, D.; Akkuş, A.F.; Bakır Kahveci, G.; Aydın, T.İ.; Erdoğan, B. Prognostic Role of the Naples Score in Extensive-Stage Small Cell Lung Cancer: A Missed Opportunity in Inflammation-Based Stratification. J. Clin. Med. 2025, 14, 5892. https://doi.org/10.3390/jcm14165892
Akgül F, Gökmen İ, Bayrakçı İ, Divriklioğlu D, Akkuş AF, Bakır Kahveci G, Aydın Tİ, Erdoğan B. Prognostic Role of the Naples Score in Extensive-Stage Small Cell Lung Cancer: A Missed Opportunity in Inflammation-Based Stratification. Journal of Clinical Medicine. 2025; 14(16):5892. https://doi.org/10.3390/jcm14165892
Chicago/Turabian StyleAkgül, Fahri, İvo Gökmen, İsmail Bayrakçı, Didem Divriklioğlu, Aysun Fatma Akkuş, Gizem Bakır Kahveci, Tayyip İlker Aydın, and Bülent Erdoğan. 2025. "Prognostic Role of the Naples Score in Extensive-Stage Small Cell Lung Cancer: A Missed Opportunity in Inflammation-Based Stratification" Journal of Clinical Medicine 14, no. 16: 5892. https://doi.org/10.3390/jcm14165892
APA StyleAkgül, F., Gökmen, İ., Bayrakçı, İ., Divriklioğlu, D., Akkuş, A. F., Bakır Kahveci, G., Aydın, T. İ., & Erdoğan, B. (2025). Prognostic Role of the Naples Score in Extensive-Stage Small Cell Lung Cancer: A Missed Opportunity in Inflammation-Based Stratification. Journal of Clinical Medicine, 14(16), 5892. https://doi.org/10.3390/jcm14165892