Yongmin Miao,1– 3 Rui Yang,1– 3 Bo Zhang,1– 3 Jun Yang,1– 3 Liang Yao,1– 3 Wanfu Wang,1– 3 Xiaoqing Liu,1– 3 Xiangyang Guo,1– 3 Hongyan Jia4 

1Department of Breast Surgery, Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, People’s Republic of China; 2Department of Breast Surgery, Shanxi Province Cancer Hospital, Taiyuan, People’s Republic of China; 3Department of Breast Surgery, Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences, Taiyuan, People’s Republic of China; 4Department of Breast Surgery, First Hospital of Shanxi Medical University, Taiyuan, People’s Republic of China

Correspondence: Hongyan Jia, Department of Breast Surgery, First Hospital of Shanxi Medical University, Taiyuan, People’s Republic of China, Email swallow_jhy@163.com

Objective: This study aims to explore whether Naples prognostic score (NPS) serves as a novel and original prognostic tool for predicting long-term survival in stage III breast cancer patients undergoing operation.
Methods: This retrospective study included 306 cases of stage III breast cancer patients hospitalized in our hospital from January 2014 to December 2018. In this study, NPS was based on five objective markers: (1) serum albumin level; (2) total cholesterol; (3) neutrophil to lymphocyte ratio; (4) lymphocyte to monocyte ratio. Survival curves of DFS and OS differences were visualized by Kaplan–Meier method and Log rank test. The variables with p < 0.05 in univariate analysis were performed in the multivariate Cox proportional hazard model analysis, and the p-values < 0.05 was considered the underlying independent variables. Nomogram was constructed by the multivariate Cox proportional hazard model analysis.
Results: Significant variations for DFS and OS categorized according to prognostic risk for the different NPS (DFS: χ2=24.926, P < 0.0001; OS: χ2=31.207, P < 0.0001). According to multivariable Cox analysis, NPS was an independent prognostic factor of DFS [Group 0 had significantly better prognosis than group 1 (HR = 2.733, 95% CI: 1.446– 5.166, P = 0.002) and group 2 (HR = 4.990, 95% CI: 2.555– 9.746), P < 0.001)] and OS [Group 0 had significantly better prognosis than group 1 (HR = 2.437, 95% CI: 1.288– 4.610, P = 0.006) and group 2 (HR = 5.707, 95% CI: 2.900– 11.231), P < 0.001)], respectively. Nomogram prognostic model exhibited excellent predictive performance on DFS [C-index: 0.692 (95% CI: 0.584– 0.782)] and OS [C-index: 0.711 (95% CI: 0.606– 0.797)] for stage III breast cancer.
Conclusion: NPS serves as a predictive tool for assessing the prognosis of stage III breast cancer after surgery. Nomogram prognostic model based on NPS show good prediction ability.

Keywords: breast cancer, Naples prognostic score, NLR, LMR, albumin