ORIGINAL ARTICLE Preoperative Neutrophil to Lymphocyte Ratio and Lymphocyte to Monocyte Ratio are Prognostic Factors in Gastric Cancers Undergoing Surgery Eva Lieto 1 & Gennaro Galizia 1 & Annamaria Auricchio 1 & Francesca Cardella 1 & Andrea Mabilia 1 & Nicoletta Basile 1 & Giovanni Del Sorbo 1 & Paolo Castellano 1 & Ciro Romano 2 & Michele Orditura 3 & Vincenzo Napolitano 1 Received: 27 May 2017 /Accepted: 19 July 2017 # 2017 The Society for Surgery of the Alimentary Tract Abstract Background Cancer outcome is considered to result from the interplay of several factors, among which host inflammatory and immune status are deemed to play a significant role. The neutrophil-to-lymphocyte ratio (NLR) and the lymphocyte-to-monocyte ratio (LMR) have been profitably used as surrogate markers of host immunoinflammatory status and have also been shown to correlate with outcome in several human tumors. However, only a few studies on these biomarkers have been performed in gastric cancer patients, yielding conflicting results. Methods Data were retrieved from a prospective institutional database. Overall survival (OS) of 401 patients undergoing surgery for gastric cancer between January 2000 and June 2015 as well as disease-free survival (DFS) rates in 297 radically resected patients were calculated. MaxStat analysis was used to select cutoff values for NLR and LMR. Results NLR and LMR did not significantly correlate with tumor stage. Patients with a high NLR and a low LMR experienced more tumor recurrences (p < 0.001) and had a higher hazard ratio (HR) for both OS (HR = 2.4 and HR = 2.10; p < 0.001) and DFS (HR = 2.99 and HR = 2.46; p < 0.001) than low NLR and high LMR subjects. Both biomarkers were shown to independently predict OS (HR = 1.65, p = 0.016; HR = 2.01, p = 0.002, respectively) and DFS (HR = 3.04, p = 0.019; HR = 4.76, p = 0.002, respectively). A score system combining both biomarkers was found to significantly correlate with long-term results. Conclusions A simple prognostic score including preoperative NLR and LMR can be used to easily predict outcome in gastric cancer patients undergoing surgery. Keywords Inflammatory and immune status . Neutrophil-to-lymphocyte ratio . Lymphocyte-to-monocyte ratio . Gastric cancers Introduction Gastric cancer is the third most common cause of cancer- related death in the world. 1 Indeed, despite surgical resection and multimodality treatment, long-term results are still disap- pointing. Therefore, new prognostic indicators capable to as- sist in cancer management decision-making are eagerly awaited. 2 Evidence is accumulating that prognosis and outcome of human malignancies do depend not only upon clinical and pathological cancer features but also on the inflammatory and immunological status of the host. 3–5 An inflamed tumor microenvironment has been shown to exert substantial cancer- promoting effects, including proliferation and survival of ma- lignant cells, angiogenesis, and metastasis. 6,7 Although im- mune cells are usually found in cancer microenvironment, their function appears to be profoundly impaired. 8 A number * Gennaro Galizia gennaro.galizia@unicampania.it 1 Division of GI Tract Surgical Oncology, Department of Surgical Sciences, Luigi Vanvitelli University of Campania School of Medicine, c/o II Policlinico, Edificio 17, Via Pansini, 5, 80131 Naples, Italy 2 Division of Internal Medicine, Department of Medical and Surgical Sciences, Luigi Vanvitelli University of Campania School of Medicine, Naples, Italy 3 Division of Medical Oncology, F. Magrassi Department of Clinical and Experimental Medicine, Luigi Vanvitelli University of Campania School of Medicine, Naples, Italy J Gastrointest Surg DOI 10.1007/s11605-017-3515-x