{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T14:20:58Z","timestamp":1791901258888,"version":"4.3.4"},"reference-count":45,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,6,9]],"date-time":"2025-06-09T00:00:00Z","timestamp":1749427200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Immune checkpoint inhibitors (ICIs) have transformed gastric cancer (GC) treatment, but response heterogeneity necessitates reliable prognostic biomarkers. This meta-analysis investigates the predictive value of metabolic (LDH, glycolytic activity) and inflammatory markers (NLR, PLR, LMR) in GC patients receiving ICIs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We systematically analyzed 17 studies (n=3,842) from major databases through March 2024. Pooled hazard ratios (HRs) for overall survival (OS) and progression-free survival (PFS) were calculated using random-effects models, with subgroup analyses by treatment type (monotherapy\/combination). Study quality was assessed via Newcastle-Ottawa Scale.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Elevated LDH significantly predicted poorer OS (HR=2.01, 95%CI:1.72-2.34) and PFS (HR=2.23, 95%CI:1.29-3.66), with minimal heterogeneity (I\u00b2=0%). Similarly, high NLR (HR=1.73) and PLR (HR=1.65) correlated with worse outcomes, while elevated LMR showed protection (HR=0.73). These associations remained consistent across treatment modalities and geographic regions (all Asian studies).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>LDH and inflammatory markers are robust, clinically accessible prognostic biomarkers in GC immunotherapy. Their validation enables improved risk stratification and supports development of combination strategies targeting metabolic-immune crosstalk to enhance ICI efficacy.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fimmu.2025.1605976","type":"journal-article","created":{"date-parts":[[2025,6,9]],"date-time":"2025-06-09T05:24:02Z","timestamp":1749446642000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":8,"title":["LDH and glycolytic activity as predictors of immunotherapy response in gastric cancer: a systematic review and 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