A total of 9 retrospective cohort studies were included for meta-analysis. Elevated NLR is associated with increased lymph node metastasis, with the increased OR being 1.79 (95% CI 1.41-2.27). All of the cohort studies were performed in Asian countries. The single non Asian study (Dutta et al) showed no increase in OR between elevated NLR and lymph node metastasis 0.97 (0.40-2.34).
This meta analysis suggests that elevated NLR predicts lymph node metastasis in gastric cancer, especially in Asian patients. This has implications on staging and management, particularly in consideration of neoadjuvant chemoradiotherapy. Given that Asian patients may have phenotypically and genetically different cancers to Caucasians, further studies are needed to compare the two populations.