The Naples Prognostic Score Predicts the Biochemical Recurrence of Patients Treated with Robot-Assisted Laparoscopic Radical Prostatectomy.

[OBJECTIVES] This study investigated whether the Naples prognostic score (NPS), derived from preoperative immunonutritional markers, can predict biochemical recurrence (BCR) amongst individuals with prostate cancer (PCa) treated surgically with robot-assisted laparoscopic radical prostatectomy (RALP).

[METHODS] This study involved a retrospective review of information obtained from patients who underwent RALP for PCa between February 2019 and June 2023. The information included patients' laboratory findings, biopsy results and postoperative pathological assessments. Participants were separated into BCR-positive and BCR-negative cohorts. Comparisons across these groups included preoperative laboratory measurements, NPS assessments and histopathological findings from biopsy and surgical specimens. Independent predictors of BCR were determined through Cox regression analysis.

[RESULTS] This analysis comprised 321 individuals treated with RALP who had a minimum postoperative follow-up of one year for BCR assessment. Cox regression analysis revealed that high preoperative prostate-specific antigen (PSA) levels (hazard rate (HR) = 1.067; 95% confidence interval (CI) = 1.018-1.109; < 0.001), postoperative specimen pathology >International Society of Urological Pathology (ISUP) 3 (HR = 2.459; 95% CI = 1.264-4.782; = 0.008), positive surgical margins (HR = 2.625; 95% CI = 1.253-5.502; = 0.011) and an NPS of 3 or 4 (HR = 2.692; 95% CI = 1.377-5.261; = 0.004) were associated with an increased risk of BCR. The NPS-only Cox regression model demonstrated a moderate predictive ability with Harrell's concordance index (C-index) of 0.654 (95% CI = 0.582-0.726), and the combined Cox regression model incorporating preoperative PSA levels, postoperative specimen pathology >ISUP 3, positive surgical margins and an NPS of 3 or 4 showed high discriminative performance with a C-index of 0.819 (95% CI = 0.761-0.877). Kaplan--Meier survival analysis revealed a statistically significant reduction in BCR-free survival amongst patients in the high-risk NPS group (57.9%) relative to those in the low-risk NPS group (81.2%) following RALP (log-rank test, < 0.001).

[CONCLUSIONS] A high NPS was found to be associated with an increased risk of BCR in patients with localised PCa. These results suggest that pretreatment NPS may serve as a useful adjunctive prognostic marker. Nevertheless, additional well-designed prospective investigations are required to validate its applicability in clinical practice.