Kosuga T, Konishi T, Kubota T, et al. - By performing this retrospective analysis of 429 patients with gastric cancer (GC) who underwent curative gastrectomy, researchers focused on the clinical value of the preoperative neutrophil-to-lymphocyte ratio (NLR) for the prediction of pathological lymph node metastasis (pN+) in GC. They assessed NLR vs computed tomography in terms of the predictive ability for pN+. According to prior studies, lymph nodes showing a minor axis of 8 mm or greater or a major axis of 10 mm or greater on computed tomography were considered as “cN+”. The range of preoperative NLR was from 0.6 to 10.8, and as per the receiver operating characteristic curve with the maximal Youden index, the optimal cut-off value for predicting pN+ was 1.6. An NLR ≥ 1.6 and cN+ were found to be independent factors related to pN+ in advanced GC (cT2-T4), as revealed in multivariate analysis. Compared with conventional modalities, a higher sensitivity (84.9%) and negative predictive value (63.9%) were yielded by a NLR ≥ 1.6 for the detection of pN+ in advanced GC, and therefore, experts concluded the possible usefulness of preoperative NLR as a complementary diagnostic tool for predicting pN+ in advanced GC.