Using paired baseline and post-induction chemotherapy (ICT) samples, circulating GDF-15 (cGDF-15) levels were quantified by enzyme-linked immunosorbent assay, and local GDF-15 tumor expression (tGDF-15) was assessed by immunohistochemistry.<h4>Results</h4>Lower baseline cGDF-15 levels (≤0.8 ng/ml) were significantly associated with increased median overall survival [21.92 (95% CI 19.73-24.16) versus 12.68 [95% confidence interval (CI) 10.56-14.81] months, <i>P</i> < 0.001, and significantly higher secondary R0 resection rates (36.5% versus 13.9%, <i>P</i> = 0.0051). The gene discussed is GDF15; the disease is neoplasm.