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

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.