Correlation Between Intratumoral NETs and Neutrophil-to-Lymphocyte Ratio in Gastric Cancer

Systemic inflammation is increasingly recognized for its impact on the progression of cancer and patient prognosis. Among relevant biomarkers, the neutrophil-to-lymphocyte ratio (NLR) has emerged as a prognostic factor for multiple malignancies. However, the clinical implications of both the circulating NLR and intratumoral neutrophil extracellular traps (NETs) in gastric cancer remain unclear. This study aimed to explore the association between preoperative NLR and the presence of NETs in tumor specimens and to evaluate their prognostic relevance.

A retrospective analysis was conducted on 52 patients who underwent curative surgery for gastric cancer between 2017 and 2018. Pre-surgical NLR values were derived from routine blood tests, and patients were stratified into two groups: NLR ≥3.5 and NLR <3.5. Correlations between tissue-based NETs and systemic NLR, as well as overall survival outcomes, were assessed.

Patients in the high NLR group exhibited significantly reduced median survival compared to those in the low NLR group (2.60 vs. 3.98 years, p = 0.014). A moderate positive correlation was observed between the NLR and NET density in tumor tissues (r = 0.507; 95% CI: 0.2714-0.685; p = 0.0001).

An elevated NLR is associated with poor survival outcomes in patients with gastric cancer and is positively correlated with NET formation in the tumor environment. These findings suggest that the NLR, along with tissue NETs, could serve as an accessible prognostic tool in clinical practice.