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Published on: March 25, 2016
Relationship between preoperative neutrophil-lymphocyte ratio and overall survival in gastric cancer: Meta-analysis
Zhenzhou Mo1, Qian Zhao2, Feng Li1
1Gastrointestinal and Pancreatic Cancer Surgery, Shanxi Provincial People's Hospital, Taiyuan, Shanxi, China.
Objective:
This meta-analysis aimed to evaluate the prognostic value of preoperative neutrophil-to-lymphocyte ratio (NLR) in patients with gastric cancer.
Methods:
We systematically searched PubMed, Web of Science, Embase, Scopus, and Cochrane CENTRAL databases from inception to May 2025 to evaluate observational studies evaluating the relationship between preoperative NLR and overall survival (OS) in patients with gastric cancer. Hazard ratios (HRs) and their 95% confidence intervals (CIs) were pooled using a random-effects model (REML, Hartung-Knapp correction). Subgroup analysis, meta-regression sensitivity analysis, and publication bias assessment were performed. Study quality was assessed using the Newcastle-Ottawa scale (NOS), and the quality of evidence was assessed by the GRADE framework.
Results:
Twenty observational studies involving a total of 3407 patients were included in this study. Elevated preoperative NLR was significantly associated with worse OS (pooled HR = 1.61; 95% CI: 1.51-1.72; p < 0.001), indicating a 61% increased risk of death. Subgroup analysis showed that the results were consistent across different geographic regions, clinical stages, treatment modalities, NLR cutoff thresholds, and sample sizes, with negligible heterogeneity (I2 = 0%). Meta-regression analysis showed that there was no significant linear correlation between HR values and the specific NLR threshold used (p = 0.47). The results of sensitivity analysis were robust, and no significant publication bias was detected (Egger test p = 0.28). Overall, the quality of evidence was rated as moderate.
Conclusion:
Elevated preoperative NLR robustly and consistently predicts worse overall survival in patients with gastric cancer, regardless of clinical stage, treatment strategy, or NLR threshold used. NLR is a convenient, reliable and clinically valuable biomarker that helps, among other aspects, to determine the prognosis and make individualized treatment decisions for patients with gastric cancer.
