Abstract: Objective To evaluate the clinical significance of preoperative serum albumin level and its association with survival in patients with gastric neuroendocrine neoplasm (gNEN). Methods Clinical data about 134 gastric neuroendocrine neoplasms patients admitted to the first medical center of Chinese PLA General Hospital from June 2001 to December 2017 were retrospectively analyzed.Patients were divided into normal serumalbumin group (≥35 g/L) and hypoalbuminemia group (<35 g/L) according to preoperative serum albumin level.Clinicopathological features were compared between the two groups.Kaplan-meier method was used to establish a survival analysis model,and log-rank test and Cox proportional risk model were used for survival analysis to explore the factors affecting postoperative survival of gNEN patients. Results Thirty-one (23%) cases were included in the hypoalbuminemia group and 103 (77%) cases in the normal serum albumin group.Preoperative serum albumin levels were associated with patients' age and tumor diameter.The 2-year survival rates of the normal serum albumin group and the hypoalbuminemia group were 66.89% and 43.29%,respectively,with significant difference (P=0.000).Univariate analysis showed that lymph node metastasis,distant metastasis,tumor TNM stage,surgical method and preoperative serum albumin level affected the postoperative survival.Cox proportional hazard model revealed that lymph node metastasis (HR:2.340;95% CI:1.260-4.346),distant metastasis (HR:2.042;95% CI:1.024-4.072),minimal invasive surgery (HR:0.361;95% CI:0.139-0.676) and preoperative serum albumin level≥35 g/L (HR:0.366;95% CI:0.208-0.643) were independent prognostic factors of the overall survival (P<0.05). Conclusion Preoperative serum albumin level is an independent prognostic factor for gastric neuroendocrine neoplasms.