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Ming-zhe Ma,1–3,* Shu-qiang Yuan,1–3,* Yong-ming Chen,1–3 Zhi-wei Zhou1–3 1State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China; 2Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; 3Department of Gastric Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China *These authors contributed equally tothis work Background: The correlations between lipid profile (lipid molecules and their derivative indexes) and clinical outcome have been widely testified in many carcinomas, but its prognostic value remains unknown in gastric cancer (GC). Our purpose in the study was to comprehensively evaluate the clinical significance of lipid profile in GC.Methods: We retrospectively collected clinical information of 1,201 GC patients who received surgery at Sun Yat-sen University Cancer Center from 2005 to 2010. Kaplan–Meier analysis and Cox proportional hazards regression model were performed to determine its prognostic significance.Results: Lipid profile including cholesterol, triglyceride, high-density lipoprotein-cholesterol (HDL-C), low-density lipoprotein-cholesterol (LDL-C), apolipoprotein A1 (ApoA1), apolipoprotein B (ApoB), LDL-C/HDL-C ratio, and ApoB/ApoA1 ratio were analyzed. For the first time, we found ApoB/ApoA1 ratio showed the biggest prognostic potency among all lipid-related variables and could act as an independent prognostic factor in GC. Patients with a high ApoB/ApoA1 ratio (≥1) had a shorter overall survival (hazard ratio: 1.373, 95% confidence interval: 1.123–1.68; P=0.002).Conclusion: Preoperative serum ApoB/ApoA1 ratio might be used as a novel prognostic indicator of GC. Keywords: ApoB/ApoA1 ratio, gastric cancer, prognosis, marker, overall survival