Huaping Ye,1,* Rong Kang,2,* Mao Chen,3 Si Zhang,3 Jinfeng Yang1 

1Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chengdu Medical College, Chengdu, People’s Republic of China; 2Department of Urology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, People’s Republic of China; 3Department of Emergency Medicine, The First Affiliated Hospital of Chengdu Medical College, Chengdu, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Jinfeng Yang, Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chengdu Medical College, No. 278, The Middle Section of Baoguang Avenue, Xindu District, Chengdu City, Sichuan Province, 610500, People’s Republic of China, Email yangjinfeng13@163.com Si Zhang, Department of Emergency Medicine, The First Affiliated Hospital of Chengdu Medical College, No. 278, The Middle Section of Baoguang Avenue, Xindu District, Chengdu City, Sichuan Province, 610500, People’s Republic of China, Email 692653629@qq.com

Objective: This study aimed to evaluate the prognostic significance of the preoperative neutrophil-to-albumin ratio (NAR) in patients with advanced gastric cancer undergoing radical gastrectomy.
Methods: A retrospective analysis was conducted involving 526 patients diagnosed with locally advanced gastric adenocarcinoma who underwent radical gastrectomy between January 2017 and December 2019. Preoperative NAR values were calculated using neutrophil count and serum albumin levels obtained within 24 hours of admission. Patients were stratified into high-NAR and low-NAR groups using an optimal cut-off value determined by receiver operating characteristic analysis. Kaplan-Meier curves, univariate, and multivariate Cox regression analyses were used to evaluate overall survival and recurrence-free survival.
Results: The optimal NAR cut-off value was identified as 2.8. Patients with high NAR exhibited significantly worse overall survival and recurrence-free survival compared to the low-NAR group. High NAR was significantly associated with advanced tumor stage, incomplete resection status, administration of chemotherapy and radiotherapy, and poor histological differentiation (all P < 0.0001). Multivariate analyses confirmed NAR as an independent prognostic factor for both overall survival (HR=2.67; 95% CI, 1.97– 4.25; p = 0.002) and recurrence-free survival (HR=3.51; 95% CI, 1.58– 5.26; p = 0.003).
Conclusion: The preoperative neutrophil-to-albumin ratio is an independent and reliable prognostic biomarker for overall and recurrence-free survival in patients with advanced gastric cancer undergoing radical gastrectomy. Due to its accessibility, simplicity, and predictive value, the neutrophil-to-albumin ratio can effectively facilitate risk stratification, personalized clinical decision-making, and targeted interventions to improve patient outcomes.

Keywords: gastric cancer, neutrophil-to-albumin ratio, prognostic biomarker, radical gastrectomy, systemic inflammation