Development of a Prognostic Nomogram Model and Establishment of a Risk Stratification System Based on the Naples Prognostic Score for Patients with Oropharyngeal Squamous Cell Carcinoma Who Have Undergone Radical Surgery

Background: The Naples prognostic score (NPS), a comprehensive indicator of inflammation and nutritional status, has demonstrated favorable prognostic predictive value in a multitude of malignant tumors. Nevertheless, its clinical significance in oropharyngeal squamous cell carcinoma (OPSCC) remains ambiguous. Methods: This is a multicenter retrospective investigation encompassing 372 patients with OPSCC who underwent radical surgery from August 2010 to September 2020. The univariate and multivariate Cox regression analyses were conducted to screen the independent prognostic factors influencing disease - free survival (DFS) and overall survival (OS). Based on these analyses, two prognostic nomogram incorporating the NPS was constructed. The predictive performance of the models was evaluated using the concordance index (C - index), receiver operating characteristic curve (ROC), calibration curve, decision curve analysis (DCA), integrated discrimination improvement index (IDI), and net reclassification index (NRI). A risk stratification system was further established according to the total risk score of the nomograms, and the survival benefit of adjuvant radiotherapy in different risk subgroups was analyzed. Results: Multivariate analysis indicated that AJCC stage, p16 expression status, perineural invasion, NPS, and age - adjusted Charlson comorbidity index (ACCI) were independent prognostic factors for DFS and OS. The constructed DFS and OS nomograms demonstrated stable prediction performance in both the training and validation sets, with C - indexes of 0.661 and 0.665, respectively, and the area under the ROC curve was greater than 0.65. The calibration curve revealed that the prediction results of the model were in good agreement with the actual observation results. DCA demonstrated that the model had a higher net clinical benefit than the AJCC staging system. The IDI and NRI analyses further corroborated the significant advantages of the new model in discrimination power and risk reclassification. The analysis based on the risk stratification system indicated that adjuvant radiotherapy was significantly associated with survival benefit only in the high - risk group, while no significant benefit was observed in the intermediate - risk and low - risk groups. Conclusion: NPS is an important independent prognostic indicator for DFS and OS in postoperative OPSCC patients. The incorporation of NPS into the nomogram can enhance the accuracy of survival prediction and offer a reference for personalized medicine.