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

• Published in: BMC gastroenterology Vol. 25; no. 1; pp. 445 - 9
• Main Authors: Yang, Shuang, Li, Zhuoyang, Wang, Tianhong, Zou, Congcong, Wang, Siman, Deng, Shuang, Hua, Yusi
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 01.07.2025; BioMed Central; BMC
• Subjects: Adjuvant treatment; Analysis; Bias; Blood cell count; Blood platelets; Cancer; Cancer patients; Cancer therapies; Chemotherapy; Cohort analysis; Development and progression; Drug therapy; Gastric cancer; Health aspects; Immunotherapy; Leukocytes (neutrophilic); Lymphocytes; Medical prognosis; Medical Subject Headings-MeSH; Meta-analysis; Multivariate analysis; Neoadjuvant chemotherapy; Neoadjuvant therapy; Neutrophil-to-lymphocyte ratio; Neutrophils; Patient outcomes; Platelet-to-lymphocyte ratio; Platelets; Prognosis; Sensitivity analysis; Stomach; Stomach cancer; Surgical outcomes; Systematic Review; Tumors; China; Neoadjuvant chemotherapy; Platelet-to-lymphocyte ratio; Neutrophil-to-lymphocyte ratio; Gastric cancer; Meta-analysis
• ISSN: 1471-230X; 1471-230X
• DOI: 10.1186/s12876-025-04056-x

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