A Novel Survival Prediction Nomogram Based on the Naples Prognostic Score and Clinicopathological Factors for Postoperative Hypopharyngeal Squamous Cell Carcinoma Patients

Abstract

Background: Hypopharyngeal squamous cell carcinoma (HSCC) is a rare yet highly aggressive malignant tumor of the head and neck. This study aims to investigate the clinical factors influencing the prognosis of HSCC and develop a prognostic prediction model combining inflammation-nutrition indicators, such as the Naples Prognostic Score (NPS). Methods: A retrospective analysis was conducted on clinical data from 292 hSCC patients who underwent radical surgery between 2007 and 2019. Univariate and multivariate Cox regression analyses were used to identify the independent prognostic factors affecting disease-free survival (DFS) and overall survival (OS). Finally, the nomogram models for predicting 3-year and 5-year DFS and OS were constructed and validated based on these factors. Results: This study included 292 hSCC patients, with a median age of 51 years. The nomograms were developed using Cox regression to predict 3-and 5-year DFS and OS, incorporating factors such as adjuvant radiotherapy, age-adjusted Charlson comorbidity index (ACCI), Naples prognostic score (NPS), and surgical safety margin. The nomograms demonstrated strong predictive performance with area under the curve (AUC) values >0.78 in both training and validation sets. It outperformed the American Joint Committee on Cancer (AJCC) staging system in terms of discriminative power, clinical utility, and reclassification, as confirmed by decision curve analysis (DCA), concordance index (C-indices), integrated discrimination improvement (IDI), and net reclassification improvement (NRI). Patients were categorized into high-, medium-, and low-risk groups based on total risk points, with significant differences in DFS and OS observed across these groups. Furthermore, the study found that adjuvant radiotherapy significantly improved survival in high-risk and medium-risk patients, while low-risk patients did not benefit. Conclusion: The results suggest that NPS is an independent prognostic factor for HSCC, and the nomogram model incorporating NPS can provide important references for individualized treatment decisions and offer new perspectives for clinical prognostic assessment.