Prognostic value and clinical integration of systemic inflammatory and nutritional biomarkers in gastric cancer

Gastric cancer remains a leading cause of cancer mortality worldwide.Although tumor-node-metastasis staging is the cornerstone of prognostic assessment, outcomes vary markedly within the same stage, highlighting the need for complementary markers.Systemic inflammatory and nutritional biomarkers reflect the interaction between tumor biology, host immunity, and nutritional status.Accessible blood-based indices -including the neutrophil-to-lymphocyte ratio, platelet-tolymphocyte ratio, lymphocyte-to-monocyte ratio, systemic immuneinflammation index, prognostic nutritional index, Glasgow Prognostic Score, and albumin-bilirubin grade -are associated with survival and recurrence in gastric cancer.This narrative review summarizes their biological basis, prognostic value, and predictive capacity for treatment benefit.We focus on their association with overall survival, disease-free survival, recurrence after gastrectomy, and response to neoadjuvant chemotherapy and immunotherapy.Routine clinical use remains limited by cutoff variability, retrospective evidence, and unstandardized assessment timing.However, dynamic ontreatment changes offer additional prognostic value over baseline measurements alone.These low-cost biomarkers are best read as adjuncts to clinicopathological variables within validated risk models rather than isolated decision rules.Progress now depends on prospective testing of prespecified thresholds, dynamic measurements, and model-based integration.