Prognostic Value of Preoperative Platelet-to-Lymphocyte Ratio in Advanced Gastric Cancer After Curative Resection

Background/Aim: Even after curative (R0) resection, a subset of patients with advanced gastric cancer (AGC) experiences poor clinical outcomes. Identifying simple and reliable preoperative prognostic indicators is essential for risk stratification. This study aimed to evaluate the clinical significance of preoperative immuno-nutritional indices, particularly the platelet-to-lymphocyte ratio (PLR), as prognostic factors after statistically controlling for confounding factors associated with the patients’ general physical status using the American Society of Anesthesiologists Physical Status (ASA-PS) classification. Patients and Methods: We retrospectively reviewed 169 patients with stage II or higher AGC who underwent R0 resection between 2012 and 2022. The impacts of various preoperative immuno-nutritional indices on overall (OS) and recurrence-free (RFS) survival were evaluated using ASA-PS-stratified log-rank tests and multivariate Cox proportional hazards regression analysis. Results: In the ASA-PS-stratified log-rank analysis, a high preoperative PLR was significantly associated with shortened OS (p=0.035) and RFS (p=0.042). Multivariate analysis demonstrated that after adjusting for general physical status, a high PLR remained an independent adverse prognostic factor for both OS (hazard ratio=1.917, 95% confidence interval=1.001-3.677; p=0.0495) and RFS (hazard ratio=1.801, 95% confidence interval=1.007-3.218; p=0.0472). Conclusion: The preoperative PLR is a simple, cost-effective, and independent prognostic indicator in patients with resectable AGC, functioning independently of the patient’s baseline physical status. This biomarker may contribute to the optimization of perioperative individualized therapeutic strategies.