Differential Impact of the Neutrophil-Lymphocyte Ratio on the Survival of Patients with Stage IV Gastric Cancer

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Background and Aim:

The neutrophil to lymphocyte ratio (NLR) may be related to progression in several cancers. The aim of this study was to investigate the impact of pretreatment NLR in advanced gastric cancer on the prognosis of the patients stratified by metastatic pattern.


We retrospectively investigated clinical data from 191 patients with stage IV gastric cancer who had undergone surgery for primary gastric cancer between 1997 and 2010 at the Department of Surgical Oncology of Osaka City University.


All patients had unresectable metastatic factors including peritoneal metastasis (P) and liver metastasis (H). Sixty-one (32%) patients had more than two unresectable factors. We determined a cutoff value of 2.5 for the NLR to be optimal to discriminate the patient's characteristics and divided patients into low (<2.5) and high (>2.5) NLR group for subsequent analysis. In the low NLR group, long survival was found in patients with H, P, or multiple site metastases.


Our results suggest that NLR well reflects the progression of critical metastasis and surgical resection might improve prognosis for patients with low NLR. In conclusion, NLR might be used as a predictive marker to decide on surgical therapy for patients with Stage IV gastric cancer.

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