{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T01:29:52Z","timestamp":1773797392176,"version":"3.50.1"},"reference-count":61,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2020,6,24]],"date-time":"2020-06-24T00:00:00Z","timestamp":1592956800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>We aimed to investigate the impact of muscle atrophy and the neutrophil-to-lymphocyte ratio (NLR), a sub-clinical biomarker of inflammation and nutrition, on the prognosis of patients with unresectable advanced gastric cancer. We retrospectively enrolled 109 patients with stage IV gastric cancer (median age 69 years; female\/male 22%\/78%; median observational period 261 days). Independent factors and profiles for overall survival (OS) were determined by Cox regression analysis and decision-tree analysis, respectively. OS was calculated using the Kaplan\u2013Meier method. The prevalence of muscle atrophy was 82.6% and the median NLR was 3.15. In Cox regression analysis, none of factors were identified as an independent factor for survival. The decision-tree analysis revealed that the most favorable prognostic profile was non-muscle atrophy (OS rate 36.8%). The most unfavorable prognostic profile was the combination of muscle atrophy and high NLR (OS rate 19.6%). The OS rate was significantly lower in patients with muscle atrophy and high NLR than in patients with non-muscle atrophy (1-year survival rate 28.5% vs. 54.7%; log-rank test p = 0.0014). In conclusion, \u201cmuscle atrophy and high NLR\u201d was a prognostic profile for patients with stage IV gastric cancer. Thus, the assessment of muscle mass, subclinical inflammation, and malnutrition may be important for the management of patients with stage IV gastric cancer.<\/jats:p>","DOI":"10.3390\/nu12061884","type":"journal-article","created":{"date-parts":[[2020,6,24]],"date-time":"2020-06-24T08:54:50Z","timestamp":1592988890000},"page":"1884","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Profiles Combining Muscle Atrophy and Neutrophil-to-Lymphocyte Ratio Are Associated with Prognosis of Patients with Stage IV Gastric Cancer"],"prefix":"10.3390","volume":"12","author":[{"given":"Kota","family":"Shigeto","sequence":"first","affiliation":[{"name":"Multidisciplinary Treatment Cancer Center, Kurume University Hospital, Kurume 830-0011, Japan"},{"name":"Division of Gastroenterology, Kurume University School of Medicine, Kurume 830-0011, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7064-4325","authenticated-orcid":false,"given":"Takumi","family":"Kawaguchi","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Kurume University School of Medicine, Kurume 830-0011, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shunji","family":"Koya","sequence":"additional","affiliation":[{"name":"Division of Rehabilitation, Kurume University Hospital, Kurume 830-0011, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Keisuke","family":"Hirota","sequence":"additional","affiliation":[{"name":"Division of Rehabilitation, Kurume University Hospital, Kurume 830-0011, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Toshimitsu","family":"Tanaka","sequence":"additional","affiliation":[{"name":"Multidisciplinary Treatment Cancer Center, Kurume University Hospital, Kurume 830-0011, Japan"},{"name":"Division of Gastroenterology, Kurume University School of Medicine, Kurume 830-0011, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sachiko","family":"Nagasu","sequence":"additional","affiliation":[{"name":"Multidisciplinary Treatment Cancer Center, Kurume University Hospital, Kurume 830-0011, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masaru","family":"Fukahori","sequence":"additional","affiliation":[{"name":"Multidisciplinary Treatment Cancer Center, Kurume University Hospital, Kurume 830-0011, Japan"},{"name":"Division of Gastroenterology, Kurume University School of Medicine, Kurume 830-0011, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tomoyuki","family":"Ushijima","sequence":"additional","affiliation":[{"name":"Multidisciplinary Treatment Cancer Center, Kurume University Hospital, Kurume 830-0011, Japan"},{"name":"Division of Gastroenterology, Kurume University School of Medicine, Kurume 830-0011, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroo","family":"Matsuse","sequence":"additional","affiliation":[{"name":"Division of Rehabilitation, Kurume University Hospital, Kurume 830-0011, Japan"},{"name":"Department of Orthopedics, School of Medicine, Kurume University, Kurume 830-0011, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Keisuke","family":"Miwa","sequence":"additional","affiliation":[{"name":"Multidisciplinary Treatment Cancer Center, Kurume University Hospital, Kurume 830-0011, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Koji","family":"Nagafuji","sequence":"additional","affiliation":[{"name":"Multidisciplinary Treatment Cancer Center, Kurume University Hospital, Kurume 830-0011, Japan"},{"name":"Division of Hematology and Oncology, Department of Medicine, Kurume University School of Medicine, Kurume 830-0011, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takuji","family":"Torimura","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Kurume University School of Medicine, Kurume 830-0011, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2020,6,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1941","DOI":"10.1002\/ijc.31937","article-title":"Estimating the global cancer incidence and mortality in 2018: GLOBOCAN sources and methods","volume":"144","author":"Ferlay","year":"2019","journal-title":"Int. J. Cancer"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1016\/j.gie.2016.06.049","article-title":"Long-term prognosis of expanded-indication differentiated-type early gastric cancer treated with endoscopic submucosal dissection or surgery using propensity score analysis","volume":"85","author":"Fukunaga","year":"2017","journal-title":"Gastrointest Endosc."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"78","DOI":"10.21037\/tgh.2019.09.14","article-title":"Effect of laparoscopic vs. open distal gastrectomy on 3-year disease free survival in patients with locally advanced gastric cancer: Commentary on the class-01 randomized clinical trial","volume":"4","author":"Wong","year":"2019","journal-title":"Transl. Gastroenterol. Hepatol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1007\/s11605-011-1707-3","article-title":"Validation of the updated 7th edition AJCC TNM staging criteria for gastric adenocarcinoma","volume":"16","author":"McGhan","year":"2012","journal-title":"J. Gastrointest. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1016\/S1470-2045(15)00553-7","article-title":"Gastrectomy plus chemotherapy versus chemotherapy alone for advanced gastric cancer with a single non-curable factor (REGATTA): A phase 3, randomised controlled trial","volume":"17","author":"Fujitani","year":"2016","journal-title":"Lancet Oncol."},{"key":"ref_6","unstructured":"Japanese Gastric Cancer, A. (2020). Japanese gastric cancer treatment guidelines 2018 (5th edition). Gastric Cancer."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1063","DOI":"10.1016\/S1470-2045(09)70259-1","article-title":"Fluorouracil versus combination of irinotecan plus cisplatin versus S-1 in metastatic gastric cancer: A randomised phase 3 study","volume":"10","author":"Boku","year":"2009","journal-title":"Lancet Oncol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e12611","DOI":"10.1111\/ecc.12611","article-title":"Visceral adiposity and cancer survival: A review of imaging studies","volume":"27","author":"Xiao","year":"2018","journal-title":"Eur. J. Cancer Care Engl."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1131","DOI":"10.1016\/j.cgh.2017.11.026","article-title":"Nonalcoholic Fatty Liver Disease Associates with Increased Overall Mortality and Death from Cancer, Cardiovascular Disease, and Liver Disease in Women but Not Men","volume":"16","author":"Hwang","year":"2018","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1016\/j.ctrv.2012.08.003","article-title":"The systemic inflammation-based Glasgow Prognostic Score: A decade of experience in patients with cancer","volume":"39","author":"McMillan","year":"2013","journal-title":"Cancer Treat Rev."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1239","DOI":"10.1007\/s11255-019-02166-6","article-title":"The relationship of blood neutrophil-to-lymphocyte ratio with nutrition markers and health outcomes in hemodialysis patients","volume":"51","author":"Campa","year":"2019","journal-title":"Int. Urol. Nephrol."},{"key":"ref_12","first-page":"216","article-title":"Reliability of the total lymphocyte count as a parameter of nutrition","volume":"28","author":"Forse","year":"1985","journal-title":"Can. J. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1245\/s10434-018-6944-1","article-title":"The Predictive Value of Pretreatment Neutrophil-to-Lymphocyte Ratio in Esophageal Squamous Cell Carcinoma","volume":"26","author":"Chen","year":"2019","journal-title":"Ann. Surg. Oncol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"11617","DOI":"10.1038\/s41598-019-48140-1","article-title":"Clinical significance of tumor-infiltrating lymphocytes and neutrophil-to-lymphocyte ratio in patients with stage III colon cancer who underwent surgery followed by FOLFOX chemotherapy","volume":"9","author":"Cha","year":"2019","journal-title":"Sci. Rep."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"83","DOI":"10.3892\/mco.2016.879","article-title":"The systemic inflammatory response as a prognostic factor for advanced hepatocellular carcinoma with extrahepatic metastasis","volume":"5","author":"Aino","year":"2016","journal-title":"Mol. Clin. Oncol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"3745","DOI":"10.21873\/anticanres.12655","article-title":"Clinical Relevance of Postoperative Neutrophil-Lymphocyte Ratio (NLR) to Recurrence After Adjuvant Chemotherapy of S-1 for Gastric Cancer","volume":"38","author":"Tanaka","year":"2018","journal-title":"Anticancer Res."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e1589","DOI":"10.1097\/MD.0000000000001589","article-title":"Prognostic Value of the Preoperative Neutrophil to Lymphocyte Ratio in Resectable Gastric Cancer","volume":"94","author":"Hsu","year":"2015","journal-title":"Medicine"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Mori, M., Shuto, K., Kosugi, C., Narushima, K., Hayashi, H., Matsubara, H., and Koda, K. (2018). An increase in the neutrophil-to-lymphocyte ratio during adjuvant chemotherapy indicates a poor prognosis in patients with stage II or III gastric cancer. BMC Cancer, 18.","DOI":"10.1186\/s12885-018-5171-2"},{"key":"ref_19","first-page":"1073","article-title":"Elevated neutrophil-to-lymphocyte ratio is associated with nutritional impairment, immune suppression, resistance to S-1 plus cisplatin, and poor prognosis in patients with stage IV gastric cancer","volume":"7","author":"Gonda","year":"2017","journal-title":"Mol. Clin. Oncol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1093\/ageing\/afy169","article-title":"Sarcopenia: Revised European consensus on definition and diagnosis","volume":"48","author":"Bahat","year":"2019","journal-title":"Age Ageing"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1016\/j.jamda.2019.12.012","article-title":"Asian Working Group for Sarcopenia: 2019 Consensus Update on Sarcopenia Diagnosis and Treatment","volume":"21","author":"Chen","year":"2020","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1101","DOI":"10.1016\/j.clnu.2017.07.010","article-title":"Prevalence and predictive value of pre-therapeutic sarcopenia in cancer patients: A systematic review","volume":"37","author":"Pamoukdjian","year":"2018","journal-title":"Clin. Nutr."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Onishi, S., Tajika, M., Tanaka, T., Hirayama, Y., Hara, K., Mizuno, N., Kuwahara, T., Okuno, N., Inaba, Y., and Kodaira, T. (2019). Prognostic Significance of Sarcopenia in Patients with Unresectable Advanced Esophageal Cancer. J. Clin. Med., 8.","DOI":"10.3390\/jcm8101647"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Gruber, E.S., Jomrich, G., Tamandl, D., Gnant, M., Schindl, M., and Sahora, K. (2019). Sarcopenia and sarcopenic obesity are independent adverse prognostic factors in resectable pancreatic ductal adenocarcinoma. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0215915"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1002\/jcsm.12274","article-title":"Preoperative sarcopenia and post-operative accelerated muscle loss negatively impact survival after resection of pancreatic cancer","volume":"9","author":"Choi","year":"2018","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e3164","DOI":"10.1097\/MD.0000000000003164","article-title":"Sarcopenia is an Independent Predictor of Severe Postoperative Complications and Long-Term Survival After Radical Gastrectomy for Gastric Cancer: Analysis from a Large-Scale Cohort","volume":"95","author":"Zhuang","year":"2016","journal-title":"Medicine"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"986","DOI":"10.1007\/s10120-015-0546-4","article-title":"Sarcopenia is associated with severe postoperative complications in elderly gastric cancer patients undergoing gastrectomy","volume":"19","author":"Fukuda","year":"2016","journal-title":"Gastric Cancer"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Zhuang, C.L., Shen, X., Zou, H.B., Dong, Q.T., Cai, H.Y., Chen, X.L., Yu, Z., and Wang, S.L. (2019). EWGSOP2 versus EWGSOP1 for sarcopenia to predict prognosis in patients with gastric cancer after radical gastrectomy: Analysis from a large-scale prospective study. Clin. Nutr., in press.","DOI":"10.1016\/j.clnu.2019.10.024"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Koch, C., Reitz, C., Schreckenbach, T., Eichler, K., Filmann, N., Al-Batran, S.E., Gotze, T., Zeuzem, S., Bechstein, W.O., and Kraus, T. (2019). Sarcopenia as a prognostic factor for survival in patients with locally advanced gastroesophageal adenocarcinoma. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0223613"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"2712","DOI":"10.1245\/s10434-017-5875-6","article-title":"Adverse Effects of Low Preoperative Skeletal Muscle Mass in Patients Undergoing Gastrectomy for Gastric Cancer","volume":"24","author":"Sakurai","year":"2017","journal-title":"Ann. Surg. Oncol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s13340-018-0345-3","article-title":"Japanese Clinical Practice Guideline for Diabetes 2016","volume":"9","author":"Haneda","year":"2018","journal-title":"Diabetol. Int."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1111\/jch.13763","article-title":"Highlights of the 2019 Japanese Society of Hypertension Guidelines and perspectives on the management of Asian hypertensive patients","volume":"22","author":"Hoshide","year":"2019","journal-title":"J. Clin. Hypertens. Greenwich"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"338","DOI":"10.5551\/jat.36004","article-title":"Lipid Management in a Japanese Community: Attainment Rate of Target Set by the Japan Atherosclerosis Society Guidelines for the Prevention of Atherosclerotic Cardiovascular Diseases 2012","volume":"24","author":"Tada","year":"2017","journal-title":"J. Atheroscler. Thromb."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1427","DOI":"10.1111\/hepr.13405","article-title":"Slow walking speed overlapped with low handgrip strength in chronic liver disease patients with hepatocellular carcinoma","volume":"49","author":"Nagamatsu","year":"2019","journal-title":"Hepatol. Res."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1111\/hepr.13453","article-title":"Clinical utility of the Liver Frailty Index for predicting muscle atrophy in chronic liver disease patients with hepatocellular carcinoma","volume":"50","author":"Hirota","year":"2020","journal-title":"Hepatol. Res."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"E22","DOI":"10.1111\/hepr.12718","article-title":"Effects of in-hospital exercise on liver function, physical ability, and muscle mass during treatment of hepatoma in patients with chronic liver disease","volume":"47","author":"Koya","year":"2017","journal-title":"Hepatol. Res."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1111\/jgh.14538","article-title":"Effects of in-hospital exercise on sarcopenia in hepatoma patients who underwent transcatheter arterial chemoembolization","volume":"34","author":"Koya","year":"2019","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1007\/s00535-017-1370-x","article-title":"Supplementation with branched-chain amino acids ameliorates hypoalbuminemia, prevents sarcopenia, and reduces fat accumulation in the skeletal muscles of patients with liver cirrhosis","volume":"53","author":"Kitajima","year":"2018","journal-title":"J. Gastroenterol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1038\/nmeth.2089","article-title":"NIH Image to ImageJ: 25 years of image analysis","volume":"9","author":"Schneider","year":"2012","journal-title":"Nat. Methods"},{"key":"ref_40","first-page":"437","article-title":"A novel technique for the determination of body fat by computed tomography","volume":"7","author":"Tokunaga","year":"1983","journal-title":"Int. J. Obes."},{"key":"ref_41","first-page":"249","article-title":"Adipose tissue volume determination in males by computed tomography and 40 K","volume":"12","author":"Kvist","year":"1988","journal-title":"Int. J. Obes."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Minamino, H., Katsushima, M., Yoshida, T., Hashimoto, M., Fujita, Y., Shirakashi, M., Yamamoto, W., Murakami, K., Murata, K., and Nishitani, K. (2020). Increased circulating adiponectin is an independent disease activity marker in patients with rheumatoid arthritis: A cross-sectional study using the KURAMA database. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0229998"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1002\/ags3.12234","article-title":"Improvement of non-alcoholic fatty liver disease after laparoscopic sleeve gastrectomy in Japanese obese patients","volume":"3","author":"Endo","year":"2019","journal-title":"Ann. Gastroenterol. Surg."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1002\/ags3.12024","article-title":"Risk factors for development of nonalcoholic fatty liver disease after pancreatoduodenectomy","volume":"1","author":"Fujii","year":"2017","journal-title":"Ann. Gastroenterol. Surg."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1264","DOI":"10.1002\/cncr.32657","article-title":"A phase 1 study of the antibody-drug conjugate brentuximab vedotin with re-induction chemotherapy in patients with CD30-expressing relapsed\/refractory acute myeloid leukemia","volume":"126","author":"Narayan","year":"2020","journal-title":"Cancer"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1111\/hepr.13436","article-title":"Profiles of advanced hepatic fibrosis evaluated by FIB-4 index and shear wave elastography in health checkup examinees","volume":"50","author":"Yamamura","year":"2020","journal-title":"Hepatol. Res."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1046","DOI":"10.1111\/hepr.13350","article-title":"High serum interleukin-34 level is a predictor of poor prognosis in patients with non-viral hepatocellular carcinoma","volume":"49","author":"Noda","year":"2019","journal-title":"Hepatol. Res."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"922","DOI":"10.1016\/j.asjsur.2019.01.006","article-title":"The long-term prognostic difference between gastrectomy with and without preoperative chemotherapy in patients with clinical stage IV gastric cancer","volume":"42","author":"Park","year":"2019","journal-title":"Asian J. Surg."},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Ministrini, S., Bencivenga, M., Solaini, L., Cipollari, C., Sofia, S., Marino, E., d\u2019Ignazio, A., Molteni, B., Mura, G., and Marrelli, D. (2020). Stage IV Gastric Cancer: The Surgical Perspective of the Italian Research Group on Gastric Cancer. Cancers, 12.","DOI":"10.3390\/cancers12010158"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1016\/j.jss.2018.06.067","article-title":"The Role of Surgical Resection for Stage IV Gastric Cancer with Synchronous Hepatic Metastasis","volume":"232","author":"Picado","year":"2018","journal-title":"J. Surg. Res."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1214","DOI":"10.7150\/jca.18707","article-title":"Elevated preoperative neutrophil-to-lymphocyte ratio can predict poor survival in early stage gastric cancer patients receiving radical gastrectomy: The Fujian prospective investigation of cancer (FIESTA) study","volume":"8","author":"Hu","year":"2017","journal-title":"J. Cancer"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1359","DOI":"10.1017\/S0007114518002854","article-title":"Prealbumin and lymphocyte-based prognostic score, a new tool for predicting long-term survival after curative resection of stage II\/III gastric cancer","volume":"120","author":"Shen","year":"2018","journal-title":"Br. J. Nutr."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"iv82","DOI":"10.1093\/annonc\/mdz155.298","article-title":"Baseline computed-tomography (CT)-evaluated sarcopenia predicts toxicity from first-line chemotherapy in metastatic gastric cancer (mGC) patients","volume":"30","author":"Catanese","year":"2019","journal-title":"Ann. Oncol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1016\/j.ejso.2014.11.040","article-title":"Sarcopenia is associated with toxicity in patients undergoing neo-adjuvant chemotherapy for oesophago-gastric cancer","volume":"41","author":"Tan","year":"2015","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"e19405","DOI":"10.1097\/MD.0000000000019405","article-title":"Prognostic significance of the neutrophil-to-lymphocyte and platelet-to-lymphocyte ratio in patients with metastatic gastric cancer","volume":"99","author":"Zhao","year":"2020","journal-title":"Medicine"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1159\/000369278","article-title":"Differential impact of the neutrophil-lymphocyte ratio on the survival of patients with stage IV gastric cancer","volume":"31","author":"Tanaka","year":"2014","journal-title":"Dig. Surg."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"e172319","DOI":"10.1001\/jamaoncol.2017.2319","article-title":"Association of Systemic Inflammation and Sarcopenia With Survival in Nonmetastatic Colorectal Cancer: Results From the C SCANS Study","volume":"3","author":"Feliciano","year":"2017","journal-title":"JAMA Oncol."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"2075","DOI":"10.1007\/s00520-015-2997-x","article-title":"Sarcopenia and inflammation are independent predictors of survival in male patients newly diagnosed with small cell lung cancer","volume":"24","author":"Go","year":"2016","journal-title":"Support. Care Cancer"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"79","DOI":"10.3892\/br.2017.924","article-title":"Increased neutrophil-to-lymphocyte ratio is a novel marker for nutrition, inflammation and chemotherapy outcome in patients with locally advanced and metastatic esophageal squamous cell carcinoma","volume":"7","author":"Sato","year":"2017","journal-title":"Biomed. Rep."},{"key":"ref_60","doi-asserted-by":"crossref","unstructured":"Borges, T.C., Gomes, T.L., Pichard, C., Laviano, A., and Pimentel, G.D. (2020). High neutrophil to lymphocytes ratio is associated with sarcopenia risk in hospitalized cancer patients. Clin. Nutr., in press.","DOI":"10.1016\/j.clnu.2020.05.005"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1016\/j.nut.2016.03.016","article-title":"Enriched enteral nutrition may improve short-term survival in stage IV gastric cancer patients: A randomized, controlled trial","volume":"36","author":"Klek","year":"2017","journal-title":"Nutrition"}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/12\/6\/1884\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T09:42:08Z","timestamp":1760175728000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/12\/6\/1884"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,6,24]]},"references-count":61,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2020,6]]}},"alternative-id":["nu12061884"],"URL":"https:\/\/doi.org\/10.3390\/nu12061884","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,6,24]]}}}