• gastric cancer;
  • neutrophil to lymphocyte ratio;
  • inflammation;
  • prognostic factor;
  • disease-free survival



Elevated neutrophil to lymphocyte ratio (N/L ratio) has been shown to be a prognostic indicator in various cancers. We aimed to investigate the prognostic significance of the preoperative N/L ratio in late stage gastric cancer.


From April 2004 to August 2007, 293 patients who had undergone gastrectomy with curative intent for the AJCC/UICC TNM Stage III or IV gastric cancer were included. N/L ratio was calculated from lymphocyte and neutrophil counts on routine blood tests taken prior to surgery.


The median follow-up time for surviving patients was 38.2 months (4.2–65.5 months) and median preoperative N/L ratio was 2.06 (range 0.47–19.73). Subjects were dichotomized at the N/L value of 2.0. A multivariate analysis established a significant relationship between the N/L ratio and overall survival (HR = 1.609; 95% confidence interval, CI, 1.144–2.264; P = 0.006). The cutoff value up to 3.0, the value of 75 percentiles, showed a significant prognostic effect on disease-free survival (HR = 1.654; 95% CI, 1.088–2.515; P = 0.019).


The results suggest that the elevated preoperative N/L ratio predicts poor disease-free and overall survival following resection for late stage gastric cancer. It may be utilized as a simple, reliable prognostic factor for risk stratification and will provide better treatment allocation. J. Surg. Oncol. 2011; 104:504–510. © 2011 Wiley-Liss, Inc.