404 Ann. Ital. Chir., 90, 5, 2019 Inflammatory and nutritional status is a predictor of long-term outcome in patients undergoing surgery for gastric cancer. Validation of the Naples prognostic score Ann. Ital. Chir., 2019 90: 404-416 pii: S0003469X19029865 Pervenuto in Redazione Gennaio 2019. Accettato per la pubblicazione Marzo 2019. Correspondence to: Gennaro Galizia, MD, PhD, Professor of Surgery Chief of Division of Surgical Oncology of the Gastrointestinal Tract, Department of Surgical Sciences ‘Luigi Vanvitelli’ University of Campania School of Medicine, c/o II Policlinico, Edificio 17 - Via Pansini 5, 80131 Naples, Italy (e-mail: gennaro.galizia@unicampania.it) Gennaro Galizia*, Annamaria Auricchio*, Ferdinando de Vita**, Francesca Cardella*, Andrea Mabilia*, Nicoletta Basile*, Michele Orditura**, Eva Lieto* University of Campania ‘Luigi Vanvitelli’, School of Medicine, Naples, Italy *Division of Surgical Oncology, Department of Surgical Sciences **Division of Medical Oncology, “F. Magrassi” Department of Clinical and Experimental Medicine Inflammatory and nutritional status is a predictor of long-term outcome in patients undergoing surgery for gastric cancer. Validation of the Naples prognostic score PURPOSE: Oncological outcome depends not only on tumor behaviour but also on nutritional and immune-infammato- ry host status. Data in gastric cancer are limited. Te main aim of this study was to prospectively assess Naples prog- nostic score (NPS) in gastric cancer patients. NPS was also compared with prognostic nutritional index (PNI), control- ling nutritional status (CONUT) score and systemic infammation score (SIS). METHODS: Overall survival (OS) and complication rates of 415 patients undergoing gastric cancer surgery from January 2000 to December 2015 were calculated. Disease-free survival (DFS) rates were assessed in 307 radically resected patients. MaxStat analysis was used to identify the best cut-of values. NPS scores were divided into 3 groups (NPS 0-3). Te receiver-operating-characteristic (ROC) curve for censored survival data was used to compare the prognostic performance of scoring systems. RESULTS: NPS positively correlated with current scoring systems (p<0.001) and advanced tumor stages (p<0.001). Patients with elevated NPS scores experienced more postoperative complications (all patients: p=0.003; radically resected patients: p=0.010). NPS1 and NPS2 patients had a higher hazard ratio (HR) than NPS0 patients for OS (NPS1 HR 2.04, NPS2 HR 4.27; p<0.001) and DFS (NPS1 HR 1.70, NPS2 HR 4.98; p<0.001). Among the diferent scoring sys- tems, only NPS was selected as an independent signifcant predictor for OS (p=0.024) and DFS (p=0.009). NPS was assigned the best prognostic performance by ROC analysis, equalling TNM staging system, and correctly identifed high- risk patients. CONCLUSIONS: NPS is an easy to calculate prognostic score strongly associated with outcome in patients undergoing gas- tric cancer surgery. KEY WORDS: Gastric cancers, Immune-nutritional and infammatory host status, Naples prognostic score recurrence rate renders long-term results still disap- pointing 1-3 . Wider implementation of diferent combi- nations of neo- and adjuvant therapies are expected to achieve better outcomes, and identifcation of prognos- tic indicators able to detect high risk patients is very desirable 4 . Tere is growing evidence that not only tumor status but also host characteristics may infuence the course of several human malignancies, including gastric cancer 5-8 . Te neutrophil-to-lymphocyte ratio (NLR) and the lymphocyte-to-monocyte ratio (LMR) have been shown to be reliable surrogate indicators of the host Introduction Current treatment and prognosis of gastric cancer are mainly based on pathological staging; however, a high READ-ONLY COPY PRINTING PROHIBITED