Naples预后评分在食管癌患者术后并发症、 再入院及长期生存预测价值的临床研究

Clinical Study on the Predictive Value of Naples Prognostic Score in Postoperative Complications, Readmission and Long-Term Survival of Patients with Esophageal Cancer

摘要: 目的：探讨基于营养与炎症指标整合的Naples预后评分(NPS)对食管癌患者术后并发症、非计划再入院及长期生存结局的预测效能，为构建更精准的食管癌预后评估模型提供临床依据。方法：本研究回顾性分析2016年4月~2023年4月我院胸外科收治的219例行食管癌根治术患者的临床资料。根据术前NPS评分将患者分为低危组(10例)、中危组(104例)、高危组(105例)。采用χ²检验比较组间差异，运用多因素Logistic回归、Cox比例风险模型分析NPS的预测价值，通过ROC曲线评估预测效能。结果：NPS高危组术后并发症发生率、再入院率均显著高于低危组(P < 0.001)；NPS预测患者术后并发症、再入院的曲线下面积(AUC)分别为0.737 (95%CI: 0.720~0.754)、0.724 (95%CI: 0.691~0.757)。生存分析显示，低、中、高危组3年总生存率分别为80.0%、57.7%和31.0% (P < 0.001)，3年无进展生存率分别为70.0%、49.0%和25.0% (P < 0.001)。多因素Cox分析证实，NPS是食管癌患者总生存期的独立预测因子(HR = 3.12, 95%CI: 2.24~4.35, P < 0.001)。结论：NPS通过整合营养与炎症指标，突破了单一指标的局限性，同时能有效预测食管癌患者的短期并发症、再入院风险和长期生存情况，可作为临床术前风险分层、个性化干预的有效工具，为食管癌围手术期管理与预后评估体系提供新参考。

Abstract: Objective: To analyze the predictive efficacy of the Naples Prognostic Score (NPS), which integrates nutritional and inflammatory indicators, for postoperative complications, unplanned readmission and long-term survival in patients with esophageal cancer, so as to provide clinical evidence for establishing a more accurate prognostic evaluation model for esophageal cancer. Methods: Clinical data of 219 patients who underwent radical esophagectomy in the Department of Thoracic Surgery of our hospital from April 2016 to April 2023 were retrospectively collected. According to preoperative NPS, patients were divided into low-risk group (10 cases), intermediate-risk group (104 cases) and high-risk group (105 cases). The χ² test was used to compare baseline differences among groups. Multivariate Logistic regression and Cox proportional hazards model were used to analyze the predictive value of NPS, and ROC curve was used to evaluate its predictive efficiency. Results: The incidence of postoperative complications and readmission rate in the high NPS group were significantly higher than those in the low-risk group (P < 0.001). The area under the curve (AUC) of NPS for predicting postoperative complications and readmission was 0.737 (95%CI: 0.720~0.754) and 0.724 (95%CI: 0.691~0.757), respectively. Survival analysis showed that the 3-year overall survival rates of the low-, intermediate- and high-risk groups were 80.0%, 57.7% and 31.0% (P < 0.001), and the 3-year progression-free survival rates were 70.0%, 49.0% and 25.0% (P < 0.001), respectively. Multivariate Cox analysis confirmed that NPS was an independent predictor of overall survival in patients with esophageal cancer (HR = 3.12, 95%CI: 2.24~4.35, P < 0.001). Conclusion: The Naples Prognostic Score integrates nutritional and inflammation-related indicators and makes up for the deficiency of single-indicator evaluation. It can effectively predict short-term postoperative complications, readmission risk and long-term survival of patients with esophageal cancer at the same time. It can be used as a practical tool for clinical preoperative risk stratification and individualized intervention, and provides a new reference for improving perioperative management and prognostic evaluation system of esophageal cancer.