Abstract: Objective To investigate the predictive value of Naples prognostic score (NPS) for the survival and prognosis of esophageal cancer patients with clinical stage Ⅲ. Methods A total of 163 esophageal cancer patients with clinical stage Ⅲ who received radical radiotherapy were retrospectively analyzed. According to the blood routine and biochemical test results before radiotherapy, NPS was calculated for each patient, and patients were divided into the low-risk group (NPS=0), the medium-risk group (NPS=1-2) and the high-risk group (NPS=3-4) for survival comparison. KaplanMeier method and Cox proportional risk model were used for univariate and multivariate analysis. The receiver operating characteristic curve (ROC) was plotted and the area under curve (AUC) was calculated. The predictive value of NPS for survival was compared with other nutritional and inflammatory indicators, such as the prognostic nutritional index (PNI), neutrophil/lymphocyte ratio (NLR) and lymphocyte/monocyte ratio (LMR). Results According to NPS before radiotherapy, the 163 patients were divided into the low-risk group (n=38), the medium-risk group (n=71) and the high-risk group (n=54). Analysis of survival in the three groups showed that the 1-, 3- and 5-year overall survival rates (OS) were 89.7%, 60.1%, 48.1%, 78.3%, 40.7%, 25.2% and 66.9%, 26.6%, 17.1% in the low-risk group, the medium-risk group and the high-risk group (χ2=16.398, P＜0.01), respectively. The 1-, 3- and 5-year progression-free survival rates (PFS) were 76.7%, 50.1%, 42.0%, 52.7%, 25.3%, 21.1% and 50.8%, 19.4%, 12.9% (χ2=16.852, P＜0.01), respectively. Multivariate analysis showed that NPS high-risk group and no chemotherapy were independent risk factors for OS and PFS. The AUC value of NPS (0.658) was larger than that of PNI (0.581), NLR (0.561) and LMR (0.578) (Z=1.938, 2.016, 1.950, P＜0.05). Conclusion NPS before radiotherapy is an independent prognostic factor for esophageal cancer patients with clinical stage Ⅲ, and its predictive value for survival is better than other nutritional and inflammatory indicators. Patients with high NPS have a relatively poor prognosis.

Key words: esophageal neoplasms, radiotherapy, prognosis, Naples prognostic score