Mady M, et al. - In patients with metastatic gallbladder cancer (GBC) treated at the Mayo Clinic between 2000 and 2016, neutrophil to lymphocyte ratio (NLR) was assessed as an independent predictor of overall survival. Patients who did not have data for neutrophils and lymphocytes were excluded. By plotting martingale residuals against NLR, the optimal cutoff point for NLR was identified. Researchers used Cox-proportional hazard regression to perform multivariate survival analysis. Of 231 patients included, 138 (60%) had NLR < 5 and 93 (40%) had NLR ≥ 5. Older age, poor performance score, lower albumin level, higher alkaline phosphatase level, and higher platelet count were more likely among patients with NLR ≥ 5. A worse overall survival was observed in association with NLR of ≥ 5 vs NLR < 5 in multivariate analysis, adjusting for age, ECOG status, albumin, ALP, AST, ALT, bilirubin, platelet count and administration of chemotherapy. NLR ≥ 5 was identified as an independently predicts poor prognosis in this patient population.