Zheng X, Chen J, Li MT. Neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, lymphocyte-to-monocyte ratio and systemic immune-inflammation index predict survival in HER2-negative advanced gastric cancer. World J Gastrointest Oncol 2026; 18(9): 124094 [DOI: 10.4251/wjgo.124094]
Corresponding Author of This Article
Xin Zheng, Director, Clinical Laboratory, Department of Laboratory, Chuzhou Hospital Affiliated to Anhui Medical University (Chuzhou First People's Hospital), No. 369 Zuiweng West Road, Nanqiao District, Chuzhou 239000, Anhui Province, China. sunnyacmilan@163.com
Research Domain of This Article
Gastroenterology & Hepatology
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research-article
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Oncol. Sep 15, 2026; 18(9): 124094 Published online Sep 15, 2026. doi: 10.4251/wjgo.124094
Neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, lymphocyte-to-monocyte ratio and systemic immune-inflammation index predict survival in HER2-negative advanced gastric cancer
Xin Zheng, Jing Chen, Meng-Ting Li
Xin Zheng, Jing Chen, Meng-Ting Li, Clinical Laboratory, Department of Laboratory, Chuzhou Hospital Affiliated to Anhui Medical University (Chuzhou First People's Hospital), Chuzhou 239000, Anhui Province, China
Author contributions: Zheng X, Chen J and Li MT designed the research study; Zheng X performed the research; Chen J and Li MT contributed new reagents and analytic tools; Zheng X analyzed the data and wrote the manuscript; and all authors have read and approve the final manuscript.
AI contribution statement: AI tools were used solely for linguistic refinement and formatting assistance. No AI tool was involved in the generation of research data, interpretation of results, or formulation of conclusions. All AI-generated outputs were critically reviewed and revised by the authors.
Institutional review board statement: The research was reviewed and approved by the Ethics Committee of the Chuzhou First People's Hospital.
Informed consent statement: All research participants or their legal guardians provided written informed consent prior to study registration.
Conflict-of-interest statement: No conflict of interest is associated with this work.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Data sharing statement: No other data available.
Corresponding author: Xin Zheng, Director, Clinical Laboratory, Department of Laboratory, Chuzhou Hospital Affiliated to Anhui Medical University (Chuzhou First People's Hospital), No. 369 Zuiweng West Road, Nanqiao District, Chuzhou 239000, Anhui Province, China. sunnyacmilan@163.com
Received: June 5, 2026 Revised: June 30, 2026 Accepted: August 28, 2026 Published online: September 15, 2026 Processing time: 95 Days and 16 Hours
Abstract
BACKGROUND
Human epidermal growth factor receptor 2 (HER2)-negative advanced gastric cancer lacks convenient prognostic biomarkers. Peripheral blood neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR) and systemic immune-inflammation index (SII) reflect tumour inflammatory status. This study hypothesizes the four indicators independently predict overall survival (OS) of such patients.
AIM
To determine the predictive value of NLR, PLR, LMR, and SII for survival in HER2-negative advanced gastric cancer.
METHODS
We retrospectively enrolled 262 HER2-negative advanced gastric cancer patients (2021-2024) split into disease control (n = 203) and progression (n = 59) groups. Baseline and inflammatory markers were collected. Kaplan-Meier, Cox regressions, nomogram and receiver operating characteristic curve analyses were performed to assess survival predictors.
RESULTS
In the disease progress group, the NLR, PLR and SII were significantly higher than in the disease control group, whilst the LMR was significantly lower; the median OS in the disease control group (19.1 months) was significantly longer than in the disease progress group (9.2 months). Multivariate Cox regression analysis revealed that elevated NLR, elevated PLR and elevated SII were independent risk factors for OS, whilst a reduced LMR was an independent protective factor. The nomogram constructed using these four indicators demonstrated good predictive performance, with a combined area under the curve of 0.764 (95% confidence interval: 0.676-0.853).
CONCLUSION
Pretreatment NLR, PLR, LMR, and SII predict survival in HER2-negative advanced gastric cancer; combined use with a nomogram aids prognosis, screening, and treatment.
Core Tip: This retrospective cohort study of 262 patients with human epidermal growth factor receptor 2-negative advanced gastric cancer demonstrates that pretreatment peripheral blood neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), and systemic immune-inflammation index (SII) are independent predictors of overall survival. Elevated NLR, PLR, and SII were risk factors, while elevated LMR was protective. The combined four-marker nomogram achieved an area under the curve of 0.764, offering a simple, cost-effective tool for early risk stratification and treatment optimization in this population.
