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目的:探讨术前外周血中性粒细胞与淋巴细胞比值(NLR)对老年胃癌根治术预后的预测价值。方法:采用回顾性队列研究方法。收集2012年1月至2015年1月兰州大学第二医院收治的216例行胃癌根治术老年患者的临床病理资料；男166例，女50例；年龄为(71±13)岁，年龄范围为65～81岁。216例患者中，89例NLR>2.86设为高NLR组，127例NLR≤2.86设为低NLR组。观察指标：(1)患者临床病理特征。(2)影响患者预后的危险因素分析。(3)随访情况。采用门诊或电话方式进行随访。了解术后肿瘤复发或远处转移及患者生存情况。随访时间截至2019年3月。总体生存时间定义为患者手术日期至终点事件发生日期(死亡日期或末次有效随访日期)。正态分布的计量资料以n ±n s表示，组间比较采用n t检验。偏态分布的计量资料以n M(范围)表示。计数资料以百分比表示，组间比较采用n χ2检验或Fisher确切概率法。采用Kaplan-Meier法计算生存率，Graphpad prism 7绘制生存曲线，采用Log-rank检验进行生存分析。采用COX比例风险模型进行单因素和多因素分析。n 结果:(1)患者临床病理特征：216例患者中，高NLR组患者淋巴细胞计数，癌胚抗原(<5.0 μg/L、≥5.0 μg/L)，CA19-9(<37.0 kU/L、≥37.0 kU/L)，幽门螺杆菌(阴性、阳性)，淋巴结转移(是、否)，术后复发转移(是、否)分别为(1.6±1.2)×10n 9个/L，54、35例，51、38例，33、56例，43、46例，18、71例，低NLR组患者上述指标分别为(1.7±1.1)×10n 9个/L，98、29例，92、35例，66、61例，42、85例，12、115例，两组患者上述指标比较，差异均有统计学意义(n t＝4.923, n χ2＝6.825、5.359、4.673、5.095、5.081，n P<0.05)。(2)影响患者预后的危险因素分析。单因素分析结果显示：年龄、淋巴细胞计数、NLR、癌胚抗原、CA19-9、幽门螺杆菌、肿瘤最大径、TNM分期、术后复发转移是影响老年胃癌患者根治术后5年总体生存率的相关因素(风险比＝1.400、0.432、1.901、1.129、1.726、2.357、2.149、1.964、5.032，95%可信区间为1.285～1.525、0.246～0.758、1.006～1.832、1.385～7.031、1.107～2.699、1.828～6.165、0.872～7.414、0.907～3.163、1.726～8.457，n P<0.05)。多因素分析结果显示：淋巴细胞计数≥1.20×10n 9/L是老年胃癌患者根治术后5年总体生存率的独立保护因素(风险比＝0.285，95%可信区间为0.103～0.792，n P2.86、幽门螺杆菌阳性、肿瘤最大径≥50 mm、TNM Ⅲ期、术后复发转移是影响老年胃癌患者根治术后5年总体生存率的独立危险因素(风险比＝2.221、2.196、1.972、2.415、4.582，95%可信区间为1.285～3.532、1.359～6.873、1.033～3.767、1.296～3.545、1.747～9.857，n P<0.05)。(3)随访情况：216例患者均获得随访，随访时间为57个月(3～84个月)。216例患者中，21例发生术后转移，9例术后复发。216例患者中位生存时间为(29±14)个月，高NLR组和低NLR组术后中位生存时间分别为(19±10)个月和(38±12)个月。高NLR组和低NLR组患者5年总体生存率分别为18.0%和35.7%，两组患者5年总体生存率比较，差异有统计学意义(n χ2＝19.330，n P<0.05)。进一步分析结果显示：117例幽门螺杆菌阳性患者中，高NLR组和低NLR组患者5年总体生存率分别为13.5%和24.3%，两组患者5年总体生存率比较，差异有统计学意义(n χ2＝5.470，n P<0.05)。99例幽门螺杆菌阴性患者中，高NLR组和低NLR组患者5年总体生存率分别为25.4%和37.1%，两组患者5年总体生存率比较，差异有统计学意义(n χ2＝5.850，n P2.86 were allocated into high NLR group, and 127 patients with NLR≤2.86 were allocated into low NLR group. Observation indicators: (1) clinicopathological characteristics of patients; (2) analysis of risk factors for the prognosis of patients; (3) follow-up. Follow-up was carried out by outpatient examination or telephone interview to detect postoperative tumor recurrence or distant metastasis and patient′s survival up to March 2019. The overall survival time was from the operation date to the end event date (date of death or the last effective follow-up date). Measurement data with normal distribution were represented asn Mean±n SD, and n t test was used for comparison between groups. Measurement data with skewed distribution were represented as n M (range). Count data were expressed as percentages, and chi-square test or Fisher exact probability method was used for comparison between groups. The Kaplan-Meier method was used to calculate survival rates, Graphpad prism 7 was used to draw survival curve, and Log-rank test was used for survival analysis. The COX proportional hazards model was used for univariate and multivariate analyses.n Results:(1) Clinico-pathological characteristics of patients: among the 216 patients, the lymphocyte count, cases carcinoembryonic antigen (CEA)<5.0 μg/L or ≥5.0 μg/mL, cases with CA19-9<37.0 kU/L or ≥37.0 kU/L, cases negative or positive for Helicobacter pylori, cases with or without lymph node metastasis, cases with or without postoperative recurrence or metastasis of the high NLR group were (1.6±1.2)×10n 9/L, 54, 35, 51, 38, 33, 56, 43, 46, 18, 71; the above indicators of the low NLR group were (1.7±1.1)×10n 9/L, 98, 29, 92, 35, 66, 61, 42, 85, 12, 115, respectively. There were significant differences in the above indicators between the two groups (n t=4.923, n χ2=6.825, 5.359, 4.673, 5.095, 5.081, P<0.05). (2) Analysis of risk factors for the prognosis of patients. Results of univariate analysis showed that age, lymphocyte count, NLR, CEA, CA19-9, Helicobacter pylori, tumor maximum diameter, TNM staging, postoperative recurrence and metastasis were the related factors affecting the postoperative 5-year overall survival rates of elderly gastric cancer patients after radical operation [n hazard ratio (n HR)=1.400, 0.432, 1.901, 1.129, 1.726, 2.357, 2.149, 1.964, 5.032; 95% n confidence interval (n CI) n as 1.285-1.525, 0.246-0.758, 1.006-1.832, 1.385-7.031, 1.107-2.699, 1.828-6.165, 0.872-7.414, 0.907-3.163, 1.726-8.457, n P<0.05). Results of multivariate analysis showed that the lymphocyte count ≥1.20×10n 9/L was an independent protective factor for the postoperative 5-year overall survival rates of elderly gastric cancer patients after radical operation (n HR=0.285, 95%n CI as 0.103-0.792, n P2.86, Helicobacter pylori infection, tumor maximum diameter≥50 mm, stage Ⅲ of TNM staging, postoperative recurrence and metastasis were independent risk factors affecting the overall 5-year survival rates of elderly gastric cancer patients after radical operation (n HR=2.221, 2.196, 1.972, 2.415, 4.582; 95%n CI as 1.285-3.532, 1.359-6.873, 1.033-3.767, 1.296-3.545, 1.747-9.857, n P<0.05). (3) Follow-up: all the 216 patients were followed up for 57 months (range, 3-84 months). Of the 216 patients, 21 had postoperative metastasis and 9 had recurrence. The median survival time of 216 patients was (29±14)months. The median postoperative survival time of the high NLR group and the low NLR group were (19±10)months and (38±12)months, respectively. The 5-year overall survival rates of patients in the high NLR group and the low NLR group were 18.0% and 35.7%, respectively, showing a significant difference between the two groups (n χ2=19.330, n P<0.05). Further analysis showed that among the 117 Helicobacter pylori-positive patients, the 5-year overall survival rates of patients in the high NLR group and the low NLR group were 13.5% and 24.3%, respectively, showing a significant difference (n χ2=5.470, n P<0.05). Among the 99 Helicobacter pylori-negative patients, the 5-year overall survival rates of patients in the high NLR group and the low NLR group were 25.4% and 37.1%, respectively, showing a significant difference (n χ2=5.850, n P<0.05).n Conclusion:Preoperative peripheral blood NLR has a good predictive value for the prognosis of elderly gastric cancer after radical resection, and high NLR indicates a worse prognosis.