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BACKGROUD: The efficacy and safety of neoadjuvant chemotherapy in patients with advanced gastric cancer were still under verification.However, accurate predictors of survival in these patients were lacking.METHODS: fifty patients were enrolled in this study, The NLR was divided into two groups as high(>2.5) and low(<=2.5).Univariate analysis on progression-free survival(PFS) and overall survival(OS) were analysed by Kaplan-Meier analysis and log-rank test, multivariate analysis was conducted by the Cox Proportional Hazards Regression Model.Whether chemotherapy normalized high NLR or not and the prognostic significance of normalization on survival were also evaluated.RESULTS: The univariate analysis showed that patients with high NLR before chemotherapy had a worse PFS and OS than those with low NLR (PFS, p=0.012 ;OS p=0.113), patients with high NLR before operation also had a worse PFS and OS (PFS, p=0.019 ; OS p=0.082), respectively.Multivariate analysis showed that NLR before operation was independent prognostic factor on PFS, however, it lost independent prognostic significance on OS.Neoadjuvant chemotherapy normalized high NLR in 11 of 24 patients, and these 11 patients had better median PFS (p=0.003) and better median OS (p=0.042) than the 13 patients who had high NLR both before chemotherapy and before operation.CONCLUSION: The NLR may serve as a potential biomarker for survival prognosis in advanced gastric cancer receiving neoadjuvant chemotherapy.Normalization of NLR indicates better outcomes.