Association of Naples Prognostic Score with Survival in Patients with Inoperable Esophageal Squamous Cell Carcinoma Undergoing Chemoradiotherapy Combined with Immunotherapy

Objective: This study aimed to determine whether the Naples Prognostic Score (NPS) is an independent predictor of overall survival (OS) and progression-free survival (PFS) in patients with unresectable esophageal squamous cell carcinoma (ESCC) undergoing chemoradiotherapy combined with immunotherapy. Materials and Methods: We analyzed 139 patients with inoperable ESCC undergoing chemoradiotherapy combined with immunotherapy between January 2020 and November 2024. We systematically evaluated the associations between NPS categories and clinical features across these cohorts. Kaplan-Meier analysis was employed to generate survival curves stratified by NPS. Univariate and multivariate Cox models assessed NPS as an independent predictor of OS and PFS for risk stratification. Results: Stratification analysis based on the NPS revealed distinct survival outcomes: the median OS was 23 months for Group 0, 17.5 months for Group 1, and 11 months for Group 2. The corresponding PFS durations were 19.5 months (Group 0), 15 months (Group 1), and 9 months (Group 2), respectively. The prognostic value of NPS was confirmed by receiver operating characteristic (ROC) curve analysis, which yielded an area under the curve (AUC) of 0.701 (P < 0.05). Importantly, multivariate Cox regression analysis established NPS as an independent prognostic factor for both OS (HR: 2.404; 95% CI: 1.411-4.095; P < 0.01) and PFS (HR: 2.203; 95% CI: 1.321-3.674; P = 0.02). These results highlight the clinical significance of NPS in prognostic assessment and treatment strategy formulation for patients with inoperable ESCC. Conclusion: The NPS has been demonstrated to be a reliable prognostic tool in unresectable ESCC. It provides a practical framework for baseline risk stratification at diagnosis to identify high-risk patients who may benefit from intensified nutritional support, closer surveillance, or enrollment in novel immunotherapy trials, thereby guiding personalized treatment and optimizing resource use.