Objective: This study aimed to investigate the prognostic value of the preoperative monocyte-to-high-density lipoprotein cholesterol ratio (MHR) and clinicopathological parameters for predicting survival outcomes in patients undergoing curative-intent gastrectomy for gastric adenocarcinoma.Methods: This retrospective cohort study analyzed data from 304 patients with histopathologically confirmed gastric adenocarcinoma who underwent curative-intent gastrectomy with standardized D1+ or D2 lymphadenectomy. The MHR was calculated using preoperative monocyte counts and HDL cholesterol levels. Patients were dichotomized based on the optimal MHR cutoff determined via receiver operating characteristic curve analysis with the Youden index. Survival outcomes, including overall survival (OS) and progression-free survival (PFS), were assessed using Kaplan–Meier analysis and compared with log-rank tests.Results: ROC analysis determined an optimal MHR cutoff of ≥11.02 (AUC: 0.654; 95% CI: 0.59–0.718), yielding sensitivities and specificities of 62.6% and 62.4%, respectively. Patients with an elevated MHR (≥11.02) had worse 5-year OS (51.4 vs. 72.2%;p< 0.001) and PFS (65.2 vs. 80.5%;p= 0.003). In the multivariate Cox regression model, elevated MHR emerged as an independent predictor of disease progression (HR: 1.93; 95% CI: 1.17–3.18;p= 0.010), while parameters such as signet ring cell histology, lymphovascular invasion, and perineural invasion were significant in univariate analyses but not in the adjusted multivariate model.Conclusions: MHR should not be regarded as a definitive predictor in isolation but rather as a cost-effective, readily obtainable adjunct within a broader preoperative risk assessment framework. Integration with other inflammation-based and clinicopathological factors may enhance predictive performance and clinical applicability.
目的：本研究旨在探讨术前单核细胞与高密度脂蛋白胆固醇比值（MHR）及临床病理参数对接受根治性胃切除术的胃腺癌患者生存结局的预测价值。 方法：这项回顾性队列研究分析了304例经组织病理学确诊为胃腺癌、接受根治性胃切除术（标准D1+或D2淋巴结清扫术）的患者数据。MHR通过术前单核细胞计数和高密度脂蛋白胆固醇水平计算得出。根据受试者工作特征曲线分析结合约登指数确定的最佳MHR截断值，将患者分为两组。采用Kaplan-Meier法评估总生存期和无进展生存期等生存结局，并通过对数秩检验进行比较。 结果：ROC分析确定最佳MHR截断值为≥11.02（曲线下面积：0.654；95%置信区间：0.59–0.718），其敏感性和特异性分别为62.6%和62.4%。MHR升高（≥11.02）的患者5年总生存期（51.4% vs. 72.2%；p < 0.001）和无进展生存期（65.2% vs. 80.5%；p = 0.003）均较差。在多变量Cox回归模型中，MHR升高是疾病进展的独立预测因子（风险比：1.93；95%置信区间：1.17–3.18；p = 0.010），而印戒细胞组织学、淋巴血管侵犯和神经周围侵犯等参数在单变量分析中具有显著性，但在调整后的多变量模型中不显著。 结论：MHR不应被视为独立的确定性预测指标，而应作为更广泛的术前风险评估框架中一种经济高效、易于获取的辅助工具。将其与其他基于炎症的指标及临床病理因素相结合，可能提升预测效能和临床适用性。
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