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This study evaluates whether the pretreatment neutrophil percentage-to-albumin ratio (NPAR) improves prognostic assessment in locally advanced nasopharyngeal carcinoma (NPC).

April 26, 2026Open Access

Pretreatment neutrophil percentage-to-albumin ratio for prognostic assessment in locally advanced nasopharyngeal carcinoma

Key Points

This study evaluates whether the pretreatment neutrophil percentage-to-albumin ratio (NPAR) improves prognostic assessment in locally advanced nasopharyngeal carcinoma (NPC).
Retrospective single-center cohort study of 804 patients with stage II-IVa NPC treated with definitive radiotherapy and/or chemotherapy.
Patients were randomly assigned to a training cohort (n=603) and a validation cohort (n=201).
Prognostic associations were analyzed using restricted cubic spline Cox models and a prognostic nomogram was developed.
Higher pretreatment NPAR was associated with reduced overall survival (HR 1.77, 95% CI 0.97-3.23; p=0.062) and progression-free survival (HR 1.74, 95% CI 0.96-3.15; p=0.066).
The model incorporating NPAR demonstrated optimism-corrected C-indices of 0.625 for overall survival and 0.617 for progression-free survival, surpassing conventional tumor-node-metastasis staging.
NPAR showed similar prognostic performance compared to the neutrophil-to-lymphocyte ratio.

Abstract

Prognosis in locally advanced nasopharyngeal carcinoma (NPC) is influenced not only by tumor burden but also by systemic inflammatory and nutritional status. This study aimed to evaluate the prognostic value of the pretreatment neutrophil percentage-to-albumin ratio (NPAR) in locally advanced NPC and to determine whether its incorporation could enhance risk stratification beyond conventional staging variables. In this retrospective single-center cohort study, we analyzed 804 patients with stage II-IVa NPC who were treated with definitive radiotherapy, with or without concurrent chemotherapy. These patients were randomly assigned to a training cohort (n = 603) and a validation cohort (n = 201). The pretreatment NPAR was calculated from blood samples collected within one week prior to treatment initiation. Associations with overall survival (OS) and progression-free survival (PFS) were primarily assessed using restricted cubic spline Cox models, supplemented by secondary cutoff-based analyses. A prognostic nomogram was developed and internally validated through bootstrap resampling. Higher pretreatment NPAR was consistently associated with adverse outcomes in OS (adjusted hazard ratio HR 1.77, 95% confidence interval CI 0.97-3.23; p = 0.062) and PFS (adjusted HR 1.74, 95% CI 0.96-3.15; p = 0.066), although these associations did not achieve conventional statistical significance in fully adjusted models. The nomogram incorporating both clinicopathological variables and NPAR demonstrated superior discrimination compared to tumor-node-metastasis staging alone, with optimism-corrected C-indices of 0.625 for OS and 0.617 for PFS. In comparative analyses, NPAR and the neutrophil-to-lymphocyte ratio exhibited similar prognostic performance. In conclusion, pretreatment NPAR is associated with adverse outcomes in locally advanced NPC and may modestly enhance model-based risk stratification. However, its clinical utility should be interpreted with caution and requires external validation.

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