Neutrophil percentage-to-albumin ratio and all-cause mortality in cancer survivors with cardiovascular disease

Neutrophil percentage-to-albumin ratio (NPAR) reflects both systemic inflammation and nutritional status, 2 factors closely linked to cancer progression and cardiovascular disease (CVD). While NPAR has been associated with adverse outcomes in various populations, its prognostic value in cancer survivors with comorbid CVD remains unclear. This study aimed to evaluate the association between NPAR and all-cause mortality in this high-risk population using nationally representative US data. We conducted a retrospective cohort study using data from the US National Health and Nutrition Examination Survey (NHANES, 1999-2018). A total of 1101 adult patients with both cancer and CVD were included. NPAR was evaluated as the exposure variable, and all-cause mortality was the outcome. Participants were categorized into tertiles according to NPAR. Kaplan-Meier survival curves were used to compare mortality across groups, and Cox proportional hazards regression models were applied to assess the independent association between NPAR and mortality risk. During a median follow-up of 77.9 months, higher NPAR levels were significantly associated with increased all-cause mortality. Kaplan-Meier analysis demonstrated significant differences in survival among tertiles (P < .0001). The median survival times were 73.0 months (IQR: 41.0-127.0), 70.0 months (IQR: 36.0-116.0), and 53.0 months (IQR: 26.8-102.0) for the lowest, middle, and highest tertiles, respectively. Multivariable Cox regression analysis confirmed that participants in the highest tertile had a significantly increased mortality risk compared with those in the middle tertile (HR = 1.54, 95% CI: 1.24-1.90, P < .001). Elevated NPAR is independently associated with higher all-cause mortality in adult cancer survivors with comorbid CVD. As a simple and readily available biomarker, NPAR may serve as a useful tool for early risk stratification and individualized management in this high-risk population.