Amorphous ITZO-Based Selector Device for Memristor Crossbar Array.

In the era of digital transformation, a memristor and memristive circuit can provide an advanced computer architecture that efficiently processes a vast quantity of data. With the unique characteristic of memristor, a memristive crossbar array has been utilized for realization of nonvolatile memory, logic-in-memory circuit, and neuromorphic system. However, the crossbar array architecture suffers from leakage of current, known as the sneak current, which causes a cross-talk interference problem between adjacent memristor devices, leading to an unavoidable operational error and high power consumption. Here, we present an amorphous In-Sn-Zn-O (a-ITZO) oxide semiconductor-based selector device to address the sneak current issue. The a-ITZO-selector device is realized with the back-to-back Schottky diode with nonlinear current-voltage (I-V) characteristics. Its nonlinearity is dependent on the oxygen plasma treatment process which can suppress the surface electron accumulation layer arising on the a-ITZO surface. The a-ITZO-selector device shows reliable characteristics against electrical stress and high temperature. In addition, the selector device allows for a stable read margin over 1 Mbit of memristor crossbar array. The findings may offer a feasible solution for the development of a high-density memristor crossbar array.

Early experience of laparoscopic resection and comparison with open surgery for gastric gastrointestinal stromal tumor: a multicenter retrospective study.

The advantages of laparoscopic resection over open surgery in the treatment of gastric gastrointestinal stromal tumor (GIST) are not conclusive. This study aimed to evaluate the postoperative and oncologic outcome of laparoscopic resection for gastric GIST, compared to open surgery. We retrospectively reviewed the prospectively collected database of 1019 patients with gastric GIST after surgical resection at 13 Korean and 2 Japanese institutions. The surgical and oncologic outcomes were compared between laparoscopic and open group, through 1:1 propensity score matching (PSM). The laparoscopic group (N = 318) had a lower rate of overall complications (3.5% vs. 7.9%, P = 0.024) and wound complications (0.6% vs. 3.1%, P = 0.037), shorter hospitalization days (6.68 ± 4.99 vs. 8.79 ± 6.50, P < 0.001) than the open group (N = 318). The superiority of the laparoscopic approach was also demonstrated in patients with tumors larger than 5 cm, and at unfavorable locations. The recurrence-free survival was not different between the two groups, regardless of tumor size, locational favorableness, and risk classifications. Cox regression analysis revealed that tumor size larger than 5 cm, higher mitotic count, R1 resection, and tumor rupture during surgery were independent risk factors for recurrence. Laparoscopic surgery provides lower rates of complications and shorter hospitalizations for patients with gastric GIST than open surgery.

A simple method for removing initial irregularity of an electrocardiogram during a transient state of a power supply in a defibrillator.

BACKGROUND: The defibrillator is a device that instantaneously discharges the high energy stored in the capacitor to the human body to help revitalize the heart. The circuit for charging the capacitor uses the same power source as the biosignal measurement unit. Therefore, variation in main power supply voltage, ground noise, and electromagnetic interference from the charging circuit can induce distortion into the biosignal at the initial stage of charging. OBJECTIVE: In this study, a simple method is proposed for removing the initial irregularity of an electrocardiogram due to the transient state of a power supply. METHODS: To evaluate the method, a 1-channel electrocardiogram measurement unit and peripheral units were separated from the main control module using galvanic isolation. An isolated push-pull converter was designed to power the secondary side. The method was tested under steady-state and transient conditions. RESULTS: The obtained results proved that biosignal distortion can be significantly reduced. CONCLUSION: This method could be another simple implementation approach for solving signal distortions due to the transient status of power supplies used in medical devices.

A simple segmentation and quantification method for numerical quantitative analysis of cells and tissues.

BACKGROUND: Microscopic image analysis based on image processing is required for quantitative evaluation of decellularization. Existing methods are not widely used because of expensive commercial software, and machine learning-based techniques lack generality for decellularization because many high-resolution image data has to be processed. OBJECTIVE: In this study, we developed an image processing algorithm for quantitative analysis of tissues and cells in a general microscopic image. METHODS: The proposed method extracts the color images obtained by the microscope into reference images consisting of grayscale, red (R), green (G), and blue (B) information and transforms each into a binary image. The transformed images were extracted by separating the cells and tissues through outlier noise elimination, logical multiplication and labeling. In order to verify the method, decellularization of porcine arotic valve was performed by the electrical method. Slice samples were obtained by time and the proposed method was applied. RESULTS: The experimental results show that the segmentation of cells and tissues, and quantitative analysis of the number of cells and changes in tissue area during the decellularization process was possible. CONCLUSIONS: The proposed method shows that cell and tissue extraction and quantitative numerical analysis were possible in different brightness of microscopic images.

Multicenter Phase 2 Study about the Safety of No Antimicrobial Prophylaxis Use in Low-Risk Patients Undergoing Laparoscopic Distal Gastrectomy for Gastric Carcinoma (KSWEET-01 Study).

BACKGROUND: Recent studies have shown a lower risk of surgical site infections (SSI) after laparoscopic distal gastrectomy compared to open surgery. This is a phase 2 study aiming to determine the incidence of SSI after laparoscopic distal gastrectomy without using antimicrobial prophylaxis (AMP). METHODS: cT1N0 gastric cancers that were subject to laparoscopic distal gastrectomy were enrolled. Based on the unacceptable SSI incidence of ≥12.5% and the target SSI incidence of ≤5%, 105 patients were enrolled with an α of 0.05 and a power of 80% (ClinicalTrials.gov, NCT02200315). RESULTS: In intention-to-treat analysis, patients did not reach the target SSI rate (12.4%, 95% confidence interval = 6.8%-19.8%). Of patients, 44 patients had a protocol violation, such as extended lymph node dissection (LND) or inappropriate nonpharmacological SSI prevention measures. Per-protocol analysis excluding these patients (n = 61) showed a SSI rate of 4.9%, which was within the target SSI range. Multivariate analysis revealed that extracorporeal anastomosis and extended LND were independent risk factors for SSI. CONCLUSIONS: This study failed to reach the target SSI rate without using AMP. However, per-protocol analysis suggests that no AMP might be feasible when limited LND and adequate SSI prevention measures were performed.

Long-Term Surgical Outcome of 1057 Gastric GISTs According to 7th UICC/AJCC TNM System: Multicenter Observational Study From Korea and Japan.

The aim of this study was to evaluate the treatment and prognosis of gastric gastrointestinal stromal tumors (GISTs) according to the 7th UICC/AJCC tumor-node-metastasis (TNM) system and the modified National Institutes of Health (NIH) risk classification. The study cohort consisted of 1057 patients with gastric GIST who underwent surgery between January 2000 and December 2007 from 13 institutions in Korea and 2 in Japan. Clinicopathologic characteristics, surgical outcomes, recurrence, and 5-year recurrence-free survival were evaluated.The mean age of the patients was 58.6 years. Thirty patients (2.8%) had distant metastasis preoperatively. Median tumor size was 4.0 cm. Complete resection (R0 resection) was achieved in 1018 patients (96.3%). Eighty-six patients (8.1%) had postoperative complications, and 2 patients (0.2%) died within 30 days after surgery. According to the 7th UICC/AJCC TNM system, 5-year recurrence-free survival rates were 95% to 99% in stage I, 94.1% in stage II, 74.1% in stage IIIA, 48.6% in stage IIIB, and 50.0% in stage IV patients. On survival analysis of high-risk patients according to the TNM system, the 5-year recurrence-free survival rates were 91.6% in stage II, 74.1% in stage IIIA, and 48.6% in stage IIIB patients. Independent factors of recurrence following surgery for gastric GIST were gender, tumor size, mitotic count, and radicality on multivariate analysis.The treatment outcome and prognosis of gastric GIST in Korea and Japan seem more favorable compared to those in Western countries. Compared to the modified NIH risk classification, the 7th UICC/AJCC TNM system is more reflective of the 5-year recurrence-free survival of patients with gastric GIST.

Effect of visceral fat area on outcomes of laparoscopyassisted distal gastrectomy for gastric cancer: subgroup analysis by gender and parameters of obesity.

PURPOSE: The aim of this study was to investigate the impact of the visceral fat area (VFA) of patients with gastric cancer undergoing laparoscopic surgery on operative outcomes such as number of retrieved lymph nodes (LNs) and operative time. METHODS: We retrospectively reviewed the medical records and the CT scans of 597 patients with gastric cancer who underwent laparoscopy assisted distal gastrectomy (LADG) with partial omentectomy and LN dissection (>D1 plus beta). Patients were stratified by gender, VFA, and body mass index (BMI), and the clinicopathologic characteristics and operative outcomes were evaluated. Multiple linear regression analysis was used to assess the effects of VFA and BMI on the number of retrieved LNs and operative time in male and female patients. RESULTS: The mean number of retrieved LNs was significantly decreased for both male and female patients with high VFA. The operative time was significantly longer for both male and female patients with high VFA. The number of retrieved LNs had a statistically significant negative correlation with VFA in both men and women, but not with BMI. The operative time had a statistically significant positive correlation with VFA in men, whereas the operative time had a statistically significant positive correlation with BMI in women. CONCLUSION: The preoperative VFA of male patients with gastric cancer who undergo LADG may affect the number of retrieved LNs and operative time. VFA was more useful than BMI for predicting outcomes of LADG.

Role of percutaneous transhepatic biliary drainage in patients with complications after gastrectomy.

OBJECTIVE: The aim of this study was to elucidate the role of PTBD in patients with DSL and ALS post-gastrectomy for malignancy or benign ulcer perforation. SUMMARY OF BACKGROUND DATA: Percutaneous transhepatic biliary drainage (PTBD) is an interventional radiologic procedure used to promote bile drainage. Duodenal stump leakage (DSL) and afferent loop syndrome (ALS) can be serious complications after gastrectomy. METHODS: From January 2002 through December 2014, we retrospectively reviewed 19 patients who underwent PTBD secondary to DSL and ALS post-gastrectomy. In this study, a PTBD tube was placed in the proximal duodenum near the stump or distal duodenum in order to decompress and drain bile and pancreatic fluids. RESULTS: Nine patients with DSL and 10 patients with ALS underwent PTBD. The mean hospital stay was 34.3 days (range, 12-71) in DSL group and 16.4 days (range, 6-48) in ALS group after PTBD. A liquid or soft diet was started within 2.6 days (range, 1-7) in the ALS group and within 3.4 days (range, 0-15) in the DSL group after PTBD. One patient with DSL had PTBD changed, and 2 patients with ALS underwent additional surgical interventions after PTBD. CONCLUSIONS: The PTBD procedure, during which the tube was inserted into the duodenum, was well-suited for decompression of the duodenum as well as for drainage of bile and pancreatic fluids. This procedure can be an alternative treatment for cases of DSL and ALS post-gastrectomy.

Risk factors associated with multiple and missed gastric neoplastic lesions after endoscopic resection: prospective study at a single institution in south Korea.

BACKGROUND/AIMS: Only a small part of visible gas tric mucosal lesion can be removed by endoscopic resection. This study is aimed to identify incidence rate and associated risk factors of multiple and missed gastric lesions, and proper timing of follow-up en doscopy. METHODOLOGY: Endoscopic surveillance was performed on 1 week, and 1, 6, 12 months af ter endoscopic resection. All multiple gastric lesions were divided into main and accessory lesions. The accessory lesions were subdivided into detected and missed lesions. RESULTS: Totally, 250 lesions of 215 patients were analyzed. There were 81 early gastric cancers, 50 high grade dysplasias and 119 low grade dysplasias. Thirty patients (14%) had multiple gastric neoplastic lesions, either adenoma or cancer, within 1 year follow-up after endoscopic resection. Old age, male gender and severe intestinal metaplasia were independent risk factors of multiple gastric lesions. Small size (≤ 1 cm) and flat morphology were major risk factors of missed lesion. Among 10 missed lesions, 9 (90%) could be detected within 6 month after resection. CONCLUSIONS: Old age, male gender, severe intestinal metaplasia were risk factors for multiple gastric lesions after endoscopic resection. Follow-up endoscopy is needed at least one time within six months after resection, with careful inspection of entire stomach.

Risk factors for duodenal stump leakage after gastrectomy for gastric cancer and management technique of stump leakage.

BACKGROUND/AIMS: The goal of this study was to elucidate the risk factors for duodenal stump leakage after gastrectomy for gastric cancer. In addition, the management of duodenal stump leakage is reviewed. METHODOLOGY: From January 2002 through December 2012, 1,195 patients with gastric cancer who underwent gastric R0 resection were enrolled in this study. The clinicopathologic features, postoperative outcomes (i.e., operation time, hospital stay, surgical procedures, method of duodenal stump closure, retrieved lymph nodes), and the risk factors of duodenal stump leakage were analyzed. RESULTS: Of the 1,195 patients, 13 patients (1.1%) suffered duodenal stump leakage. Most of the patients with duodenal stump leakage were male (92.3%). Nine patients underwent a subtotal gastrectomy with Billroth- II or Roux-en-Y anastomosis; the other four patients underwent a total gastrectomy with a Roux-en-Y anastomosis. There were two mortalities. With univariate and multivariate analysis, age was the most predictable factor for duodenal stump leakage (p= 0.034, p=0.044) CONCLUSIONS: Duodenal stump leakage was affected by the age. For older patients who undergo a radical gastrectomy for gastric cancer, the surgeon must pay meticulous attention to the transection and mobilization of the duodenum in order to prevent duodenal stump leakage.

How much progress has been made in minimally invasive surgery for gastric cancer in Korea?: a viewpoint from Korean prospective clinical trials.

Gastric cancer is the most common cancer in Korea. Because the incidence of gastric cancer is still high even with early detection and because of developments in surgical instruments and technological advances, minimally invasive surgery has rapidly become an accepted treatment for gastric cancer in Korea. Many Korean gastric surgeons have contributed to the rapid adaptation of minimally invasive surgery for gastric cancer: not only the Korean Laparoscopic Gastrointestinal Surgery Study (KLASS) group, but also other expert surgeons after the 2000s. Thanks to their vigorous efforts involving active learning, education, workshops, academic communications, and international communications with active laparoscopic gastric surgeons in Korea, numerous results and well-designed large-scale clinical studies have been published or are actively ongoing, thus increasing its wide acceptance as an option for gastric cancer. Now, Korea has become one of the leading countries using minimally invasive surgery for the treatment of gastric cancer. This review article will summarize the current status and issues, as well as the clinical trials that have finished or are ongoing, regarding minimally invasive surgery for gastric cancer in Korea.

Comprehension of readmission after laparoscopy assisted distal gastrectomy: what are the causes?

PURPOSE: The aim of this study is to evaluate long-term outcomes regarding readmission for laparoscopy-assisted distal subtotal gastrectomy (LADG) compared to conventional open distal subtotal gastrectomy (CODG) for early gastric cancer (EGC). METHODS: Between January 2003 and December 2006, 223 and 106 patients underwent LADG and CODG, respectively, for EGC by one surgeon. The clinicopathologic characteristics, postoperative outcomes, postoperative complications, overall 5-year survival, recurrence, and readmission were retrospectively compared between the two groups. RESULTS: Multiple readmission rate in LADG was significantly less than that in CODG (0.4% vs. 3.8%, P = 0.039), although the readmission rate, reoperation rate after discharge, and mean readmission days were not significantly different between the two groups. Readmission rates of the LADG and CODG groups were 12.6% and 14.2%, respectively. First flatus time and postoperative hospital stay was significantly shorter in the LADG group. However, there was no significant difference in the complication rates between the two groups. Overall 5-year survival rates of the LADG and CODG group were 100% and 99.1% (P = 0.038), respectively. CONCLUSION: Compared to the CODG group, the LADG group has several advantages in surgical short-term outcome and some benefit in terms of readmission in surgical long-term outcome for patients with EGC, even though the oncologic outcome of LADG is similar to that of CODG over 5 years.

Analysis of prognostic factors and outcomes of gastric cancer in younger patients: a case control study using propensity score methods.

AIM: To understand the clinicopathological and prognostic features of gastric cancer in younger and older patients. METHODS: Between January 2002 and December 2008, 1667 patients underwent curative gastric surgery. For comparative purposes, the patients were divided into two groups: younger patients who were less than 40 years old (112 patients), and older patients who were 40 years old and older (1555 patients). In both groups, propensity scoring methods were used to select patients with similar disease statuses. A total of 224 matched cases, with 112 patients in each group, were included in the final analysis. RESULTS: Compared to the older group, the younger group with gastric cancer had a significantly higher percentage of females (P = 0.007), poorly differentiated or signet ring cell carcinoma (P < 0.001), advanced T stage gastric cancer (P = 0.045), and advanced tumor-node-metastasis stage cancer (P = 0.036). The older group with gastric cancer had more comorbidities (P < 0.001). With the exception of the number of lymph node dissection (P < 0.001) and retrieved lymph node (P = 0.010), there were no statistically significant differences between the postoperative outcomes of the two groups. During the follow-up period, there were 19 recurrences in the younger group and 11 recurrences in the older group. The overall five-year survival rates in the younger and older groups were 84.3% and 89.6%, respectively (P = 0.172). There were no significant differences (P = 0.238) in the overall survival of patients with advanced T stage gastric cancer in the two groups, with five-year survival rates of 70.8% in the younger group and 79.5% in the older group. With regard to the age-adjusted survival rate, there was significant difference between the two groups (P = 0.225). CONCLUSION: In spite of aggressive cancer patterns in the younger group with gastric cancer, the younger group did not have a worse prognosis than the older group in our study.

Is the rate of postoperative complications following laparoscopy-assisted gastrectomy higher in elderly patients than in younger patients?

BACKGROUND: With an increase in life expectancy, very elderly patients are presenting with gastric cancer more commonly than ever. The present study retrospectively analyzed the surgical outcomes of laparoscopy-assisted gastrectomy for gastric cancer in the young, elderly, and very elderly age groups. METHODS: The study group consisted of 1,055 patients who underwent laparoscopy-assisted gastrectomy between February 2002 and December 2012. We divided these patients into three groups; group 1 (young age, <65 years), group 2 (elderly age, 65-74 years), and group 3 (very elderly age, ≥75 years). RESULTS: There were statistical differences in the rates of postoperative complications among the three groups (P = 0.008). However, when assessed according to the severity of postoperative complications based on the Clavien-Dindo classification, there was no statistical difference among the three groups (P = 0.562). CONCLUSIONS: Laparoscopy-assisted gastrectomy for gastric cancer can be performed in very elderly patients. In analyzing studies of elderly patients with postoperative complications following the procedure, not only should the rate of postoperative complications be taken into consideration, but also the severity of any postoperative complications.

Readmissions following elective radical total gastrectomy for early gastric cancer: a case-controlled study.

BACKGROUND: Readmission after gastrectomy is one of the factors that reflect quality of life. Therefore, we analyzed the several factors related to readmissions after total gastrectomy for early gastric cancer. METHODS: From January 2002 through December 2009, 102 consecutive patients who underwent radical total gastrectomy for early gastric cancer were enrolled in this study. We evaluated the incidence, cause, time point, and type of treatment for readmission after discharge; we compared the readmission and non-readmission groups in regard to clinicopathologic features and postoperative outcomes. RESULTS: The readmission rate during the five years after total gastrectomy was 22 of 102 (21.6%). The most common cause for readmission was esophagojejunostomy stricture (5 cases). The treatment given for 31 readmissions included 23 conservative therapies, 3 radiologic or endoscopic interventions, and 5 re-operations. No significant differences were detected in the clinicopathologic feature, postoperative outcomes, or 5-year survival rates between the readmission and non-readmission group. No specific risk factor was found to be associated with readmission. CONCLUSION: Although we could not determine a specific risk factor associated with readmission after radical total gastrectomy, prevention of readmission by evaluating the causes and treatments after radical total gastrectomy can improve the patient's quality of life.

The differences in clinicopathological features and prognosis among the subtypes of signet ring cell, mucinous, papillary, and lymphoepithelioma-like carcinoma in advanced gastric cancer.

BACKGROUND/AIMS: There are differing histologic subtypes of gastric cancer. We investigated the clinicopathological features and prognosis of: signet ring cell (SRC), mucinous (MGC), papillary (PGC), and lymphoepithelioma-like (LELC) carcinoma in advanced gastric cancer. METHODOLOGY: One hundred thirty six advanced gastric cancer patients, including 62 SRCs, 43 MGCs, 9 PGCs, and 22 LELCs, who underwent R0 gastrectomy between 2002 and 2013, were retrospectively evaluated. RESULTS: There were significant differences in several clinicopathological features. There were found to be statistical differences in postoperative outcomes in the type of gastrectomy and type of anastomosis (p<0.001 and p<0.001, respectively). In terms of overall survival analysis, there was no statistical survival difference among the subtypes of advanced gastric cancer (p=0.088). However, LELC had a better prognosis than the other groups. CONCLUSIONS: There were some differences in several of the clinicopathological features of the subtypes advanced gastric cancer. Although there were no statistical differences in survival, those with LELC showed a better prognosis than did the other groups. Therefore, the treatment of advanced gastric cancer should be individualized, and prognosis considered, according to the subtype.

Is laparoscopy-assisted total gastrectomy feasible for the treatment of gastric cancer? A case-matched study.

BACKGROUND: The aim of this study was to clarify the short- and long-term outcomes of laparoscopy-assisted total gastrectomy (LATG) for gastric cancer compared to conventional open total gastrectomy (COTG) with a case-control study. METHODS: Between January 2002 and December 2010, a series of 264 patients with gastric cancer underwent R0 total gastrectomy (61 LATG patients and 203 COTG patients). Age, gender, and pathological stage were matched by propensity scoring, and 120 patients (60 LATG and 60 COTG) were selected for analysis. RESULTS: There were no significant differences in the clinicopathological features between the two groups. Regarding postoperative outcomes, first flatus time was significantly shorter in the LATG group than in the COTG group (p < 0.001), while operation time was significantly longer in the LATG group than in the COTG group (p < 0.001). Postoperative complications occurred in 5 cases (8.3%) of the LATG group and in 11 cases (18.3%) of the COTG group (p = 0.178). There were two recurrences in the LATG group and three recurrences in the COTG group. There was no significant difference in the 5-year survival rate between the two groups (p = 0.667). CONCLUSIONS: LATG for gastric cancer may be both feasible and efficient compared to COTG for experienced laparoscopic surgeons. This study is valuable for a prospective randomized controlled trial of LATG for gastric cancer in a larger number of patients.

In-plane switching of vertically aligned negative liquid crystals for high transmittance and wide viewing angle.

We propose a method for in-plane switching of vertically aligned negative liquid crystals (LCs) for high transmittance and wide viewing angle. By applying an in-plane electric field using a double-layered electrode structure, LC molecules can be rotated by the vertical as well as the in-plane components of the applied field over the entire region so that high transmittance can be achieved. The threshold voltage difference can be obtained simply by varying the electrode structure, which can reduce the off-axis gamma shift in a multidomain vertical alignment LC cell.

Association between phosphorylated AMP-activated protein kinase and MAPK3/1 expression and prognosis for patients with gastric cancer.

OBJECTIVES: Phosphorylated AMP-activated protein kinase (pAMPK) plays a central role in cellular metabolic sensing and energy balance homeostasis, and interacts with various pathways [e.g., TP53, mTOR, NUAK2 (sucrose nonfermenting-like kinase), MAPK3/1 (ERK) and PDK]. Therefore, the present study analyzed the expression of pAMPK, NUAK2, MAPK3/1 and PDK-1 and their effect on the survival of patients with resected gastric cancer. METHODS: A total of 621 patients with gastric adenocarcinoma surgically resected with curative intent were enrolled in the study. Immunohistochemical staining for pAMPK, NUAK2, MAPK3/1 and PDK-1 was performed using tissue microarrays of surgical specimens of gastric cancer tissue. RESULTS: Positive pAMPK, NUAK2, MAPK3/1 and PDK-1 expression was observed in 379 (61.0%), 257 (41.4%), 327 (52.7%) and 67 (10.8%) cases, respectively. Multivariate survival analysis showed a significantly better survival for the patients with positive pAMPK or MAPK3/1 expression than for the patients with a negative expression [pAMPK: disease-free survival (DFS), hazard ratio (HR) = 0.750, 95% confidence interval (CI) = 0.568-0.970, p = 0.030; MAPK3/1: DFS, HR = 0.692, 95% CI = 0.720-0.974, p = 0.021), while NUAK2 or PDK-1 expression had no effect on survival. CONCLUSION: pAMPK or MAPK3/1 expression was found to be an independent prognostic marker for patients with resected gastric cancer.

Prognostic significance of neutrophil lymphocyte ratio and platelet lymphocyte ratio in advanced gastric cancer patients treated with FOLFOX chemotherapy.

BACKGROUND: Several inflammatory response materials could be used for prediction of prognosis of cancer patients. The neutrophil lymphocyte ratio (NLR), and the platelet lymphocyte ratio (PLR) have been introduced for prognostic scoring system in various cancers. The objective of this study was to determine whether the NLR or the PLR would predict the clinical outcomes in advanced gastric cancer patients treated with oxaliplatin/ 5-fluorouracil (FOLFOX). METHODS: The study population consisted of 174 advanced gastric cancer patients. Patients were treated with 85 mg/m2 of oxaliplatin as a 2-h infusion at day 1 plus 20 mg/m2 of leucovorin over 10 min, followed by 5-FU bolus 400 mg/m2 and 22-h continuous infusion of 600 mg/m2 at days 1-2. Treatment was repeated in 2-week intervals. The NLR and PLR were calculated from complete blood counts in laboratory test before and after first cycle of chemotherapy. RESULTS: NLR was a useful prognostic biomarker for predicting inferior overall survival (OS) (p = 0.005), but was not associated with progression free survival (PFS) (p = 0.461). The normalization of NLR after one cycle of chemotherapy was found to be in association with significant improvement in PFS (5.3 months vs. 2.4 months, p < 0.001), and OS (11.9 months vs. 4.6 months, p < 0.001). The normalization of PLR was also associated with longer PFS (5.6 months vs. 3.4 months, p = 0.006), and OS (16.9 months vs. 10.9 months, p = 0.002). In multivariate analysis, changes in NLR were associated with PFS (Hazard ratio (HR): 2.297, 95% confidence interval (CI): 1.429-3.693, p = 0.001). The NLR, (HR: 0.245, 95% CI: 0.092-0.633, p = 0.004), PLR (HR: 0.347, 95% CI: 0.142-0.847, p = 0.020), changes in NLR (HR: 2.468, 95% CI: 1.567-3.886, p < 0.001), and changes in PLR (HR: 1.473, 95% CI: 1.038-2.090, p = 0.030) were independent prognostic markers for OS. CONCLUSION: This study demonstrates that NLR, PLR, and changes in NLR or PLR are independent prognostic factor for OS in patients with advanced gastric cancer treated with chemotherapy. These specific factors may also help in identifying the patients, who are more sensitive to FOLFOX regimen.