Elevated neutrophil to lymphocyte ratio (N/L ratio) has been shown to be a prognostic indicator in various cancers. We aimed to investigate the prognostic significance of the preoperative N/L ratio in late stage gastric cancer. From April 2004 to August 2007, 293 patients who had undergone gastrectomy with curative intent for the AJCC/UICC TNM Stage III or IV gastric cancer were included. N/L ratio was calculated from lymphocyte and neutrophil counts on routine blood tests taken prior to surgery. The median follow-up time for surviving patients was 38.2 months (4.2-65.5 months) and median preoperative N/L ratio was 2.06 (range 0.47-19.73). Subjects were dichotomized at the N/L value of 2.0. A multivariate analysis established a significant relationship between the N/L ratio and overall survival (HR=1.609; 95% confidence interval, CI, 1.144-2.264; P=0.006). The cutoff value up to 3.0, the value of 75 percentiles, showed a significant prognostic effect on disease-free survival (HR=1.654; 95% CI, 1.088-2.515; P=0.019). The results suggest that the elevated preoperative N/L ratio predicts poor disease-free and overall survival following resection for late stage gastric cancer. It may be utilized as a simple, reliable prognostic factor for risk stratification and will provide better treatment allocation. Copyright © 2011 Wiley-Liss, Inc.