The prognostic value of preoperative Naples prognostic score for overall survival and progression-free survival in colorectal cancer.

[BACKGROUND] This study aimed to explore the prognostic value of the Naples Prognostic Score (NPS) for progression-free survival (PFS), overall survival (OS) and sarcopenia in patients with colorectal cancer (CRC).

[METHODS] The Kaplan-Meier (KM) method was used to plot survival curves for PFS and OS, and the Log-rank test was applied to compare survival differences between the two groups. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive efficacy of NPS for PFS and OS in CRC patients. Univariate and multivariate Cox proportional hazards regression models were used to identify independent risk factors affecting PFS, OS, and sarcopenia. Nomograms were developed based on PFS and OS to forecast the 1-year, 3-year, and 5-year prognosis of CRC patients, while the concordance index (C-index) and calibration curves were used to assess the predictive performance of these nomograms.

[RESULTS] Kaplan-Meier analysis revealed that patients in the high-NPS (scores 3–4) group were significantly associated with poor prognosis (PFS: 48.9% vs. 66.0%,  < 0.001; OS: 48.9% vs. 66.0%,  < 0.001). Multivariate Cox regression confirmed that the high-NPS group was an independent risk factor for PFS (HR = 1.485, 95% CI: 1.241–1.777,  < 0.001), OS (HR = 1.452, 95% CI: 1.219–1.729,  < 0.001), and sarcopenia (HR = 1.876, 95% CI: 1.403–2.507,  < 0.001). For the nomograms developed based on the independent prognostic factors for PFS and OS, the areas under the ROC curve (AUC) for 1-year, 3-year, and 5-year outcomes were 0.807, 0.776, and 0.766 for PFS, and 0.772, 0.775, and 0.769 for OS, respectively. The C-indices of the nomograms were 0.795 for PFS and 0.815 for OS. Calibration curves demonstrated good agreement between predicted and actual values. Decision curve analysis (DCA) confirmed that the nomograms provided a better clinical net benefit than tumor staging alone.

[CONCLUSIONS] The preoperative NPS is a promising prognostic scoring method for predicting poor outcomes in CRC patients. The prognostic nomogram based on NPS can serve as an effective tool for the comprehensive prognostic evaluation of CRC patients.

[SUPPLEMENTARY INFORMATION] The online version contains supplementary material available at 10.1186/s12885-026-15679-y.