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. 2025 Jul 1;25(1):445.
doi: 10.1186/s12876-025-04056-x.

Correlation between neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio with prognosis in gastric cancer patients undergoing neoadjuvant chemotherapy: a meta-analysis

Shuang Yang  1 , Zhuoyang Li  2   3 , Tianhong Wang  4 , Congcong Zou  5 , Siman Wang  6 , Shuang Deng  7 , Yusi Hua  8
Affiliations

Correlation between neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio with prognosis in gastric cancer patients undergoing neoadjuvant chemotherapy: a meta-analysis

Shuang Yang et al. BMC Gastroenterol. .

Abstract

Introduction: Inflammatory markers such as the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are associated with poorer prognosis of gastric cancer (GC) patients and may guide treatment decisions. This meta-analysis aims to evaluate the impact of NLR and PLR on the prognosis of GC patients undergoing neoadjuvant chemotherapy (NAC).

Methods: Cochrane, Embase, PubMed and Web of science were searched for studies up to November 30, 2024. Meta-analysis was conducted to evaluate the pooled effect. Sensitivity analysis was conducted by removing a different study each time. Publication bias was assessed by Egger’s test and Begg’s test to evaluate quantitatively.

Results: A total of 16 studies were included in this meta-analysis from 3,094 studies. Pre-NAC high NLR level was associated with poorer overall survival outcomes (HR = 1.96, 95% CI 1.21–3.20). Similarly, post-NAC high NLR was also correlated with worse overall survival outcomes (HR = 1.69, 95% CI 1.04–2.76). However, pre-NAC PLR and post-NAC PLR did not appear to exhibit a significant correlation with the prognosis of gastric cancer patients following NAC.

Conclusion: NLR is emerging as a potential prognostic indicator for gastric cancer, particularly in patients receiving NAC. Elevated NLR levels both before and after NAC are associated with poorer overall survival outcomes in gastric cancer patients.

Supplementary Information: The online version contains supplementary material available at 10.1186/s12876-025-04056-x.

Keywords: Gastric cancer; Meta-analysis; Neoadjuvant chemotherapy; Neutrophil-to-lymphocyte ratio; Platelet-to-lymphocyte ratio.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Our study was conducted in strict accordance with the relevant provisions of the Declaration of Helsinki. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

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