The prognostic determinants for gastric signet ring cell carcinoma (GSRC) remain inadequately characterized. This study aimed to predict survival outcomes in GSRC patients by developing and validating a model incorporating the neutrophil–lymphocyte ratio (NLR). We retrospectively analyzed 147 GSRC patients treated at the Department of Surgical Oncology, Neimenggu Baogang Hospital, Inner Mongolia Medical University. Using Cox proportional hazards regression, a predictive model was constructed, and its accuracy was assessed via ROC curves. Our analysis revealed that patients with NLR ≤ 2.8 had significantly improved overall survival (OS) (P < .001, (Figure 1a)) and lower rates of tumor recurrence (P = .036, (Figure 1b)) compared to those with NLR > 2.8. Multivariate analysis confirmed that NLR ≤ 2.8 (HR: 2.625, 95% CI: 1.505–5.3166, P = .003), larger tumor size (HR: 3.024, 95% CI: 1.521–4.186, P = .005), and tumor metastasis (HR: 3.303, 95% CI: 1.25–4.525, P = .012) independently predicted both OS and tumor recurrence. Incorporating NLR enhanced model performance (AUC: 0.826 vs. 0.798 without NLR), highlighting its prognostic relevance. These findings suggest that elevated NLR is an independent indicator of poor prognosis post-surgery and may assist clinicians in selecting optimal therapeutic strategies for high-risk GSRC patients.
