In this retrospective study we identified preoperative serum prealbumin level (HR = 2.89, p = 0.041) and PNI (HR = 4.76, p = 0.049) as independent risk factors for predicting ≥ grade 3 neutropenia event in cycle 1 of gastric cancer patients receiving adjuvant chemotherapy. Here, TTR is linked to Decreased total neutrophil count.