Predictive Value of Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios for Distant Metastasis in Vietnamese Gastric Cancer Patients

Abstract Background Gastric cancer (GC) remains a leading cause of global cancer mortality, with a high prevalence of distant metastasis at diagnosis in Vietnam. Systemic inflammatory markers are emerging as potential tools for risk assessment, yet their independent predictive value in the Vietnamese population requires further clarification. Objective To evaluate the predictive value of the Neutrophil-to-Lymphocyte Ratio (NLR) and Platelet-to-Lymphocyte Ratio (PLR) as cost-effective biomarkers for distant metastasis in Vietnamese GC patients. Design A single-center, retrospective cohort study of 114 GC patients treated at the Oncology Hospital of Ho Chi Minh City between January and June 2023. Methods Patients were categorized into metastatic (Stage IV) and non-metastatic groups per AJCC 8th edition criteria. Pretreatment NLR and PLR were calculated from peripheral blood counts. The optimal cutoffs were determined using receiver operating characteristic (ROC) curve analysis. DeLong’s test was employed to compare the diagnostic efficacy of the clinical model versus the combined clinical-hematological model. Univariate and multivariate binary logistic regression analyses were performed to identify independent predictors of distant metastasis. Results Metastasis was present in 44.7% of cases. Optimal cutoffs of 2.0 for NLR and 181.5 for PLR were identified. Both markers were significantly higher in the metastatic group (p<0.01) and positively correlated with disease progression. A combined model integrating clinical factors with NLR and PLR demonstrated superior diagnostic accuracy compared to clinical factors alone (AUC: 0.766 vs 0.619, p=0.0036). In multivariable analysis, multiple tumor location and high PLR remained independent prognostic factors for distant metastasis. Conclusion Elevated NLR and PLR are significantly associated with distant metastasis in GC. Integrating these accessible, minimally invasive markers with clinical data enhances predictive accuracy, providing a practical tool for risk stratification in resource-limited settings. Plain Language Summary The Challenge Gastric cancer (stomach cancer) is a leading cause of cancer-related deaths worldwide. In Vietnam, many patients are diagnosed only after the cancer has already spread to distant parts of the body (metastasis). When cancer spreads, it becomes much harder to treat. Doctors need affordable and reliable ways to predict which patients are at a higher risk of metastasis to improve how they manage the disease. The Study Researchers studied 114 gastric cancer patients at the Ho Chi Minh City Oncology Hospital. They looked at two specific markers found in routine, inexpensive blood tests: the Neutrophil-to-Lymphocyte Ratio (NLR) and the Platelet-to-Lymphocyte Ratio (PLR). These markers measure the balance of different white blood cells and platelets, which partially reflect the body’s “inflammation” levels in response to a tumor. The Findings The study found that patients with advanced, metastatic cancer had significantly higher NLR and PLR levels compared to those in earlier stages. By combining these blood markers with other clinical information—such as the patient’s and tumor’s data —the researchers created a predictive model. This combined model was much more accurate at identifying patients with distant metastasis than using clinical information alone. The Impact Because these blood tests are simple, low-cost, and already widely available in hospitals, they offer a practical way for doctors to monitor cancer progression. Using the NLR and PLR ratios can help healthcare providers in Vietnam and elsewhere better identify high-risk patients and personalize their treatment plans more effectively.