Objective To investigate the relationship between preoperative prognostic nutritional index(PNI) and prognosis in elderly patients with gastric cancer.Methods The clinical data of 62 patients over age 65 with gastric cancer who underwent radical gastrectomy for gastric cancer were retrospectively analyzed.PNI values were calculated and the relationship between PNI and untoward reactions and prognosis were discussed.Results PNI value is closely related with patient age(t=5.576,P<0.001),tumor size(x2=4.846,P=0.033),lymphatic metastasis(x2=13.742,P<0.001),preoperative CEA level(t=5.226,P<0.001).Among the 62 patients,12 cases with high-PNI had recurrence and 5 patients died during the follow-up period, while 11 case in low-PNI had a recurrence and 7 patients died.The recurrent rate(x2=4.055,P=0.044) and mortality rate(x2=4.630,P=0.043) of the high-PNI group were significantly lower than the low-PNI group.Conclusion PNI is a simple and useful marker for predicting the long-term outcomes of elderly gastric cancer patients, which should be included in the routine assessment of gastric cancer patients.