Preoperative Lactate Dehydrogenase-to-Albumin Ratio and Overall Survival in Gastric Cancer: Stage-Specific Prognostic Implications

Objective: To evaluate the prognostic value of the preoperative serum lactate dehydrogenase-to-albumin ratio (LAR) in patients with gastric cancer (GC), with a focus on its stage-specific implications for overall survival (OS). Methods: This single-center retrospective cohort study included 568 patients with resected GC. Patients were categorized into low-LAR and high-LAR groups for comparative analysis. The baseline characteristics, short-term postoperative outcomes, and OS were compared between the two groups. Cox proportional hazards regression was performed to identify the independent risk factors for OS. Kaplan–Meier analysis was used to assess OS across tumor stages in the two LAR groups. Results: In total, 568 patients were enrolled. Patients in the high-LAR group were older and had a lower body mass index (BMI), while also showing higher preoperative lactate dehydrogenase level, lower albumin level, and a greater number of retrieved lymph nodes. Univariate and multivariate analyses indicated that BMI was independently associated with a favorable OS. Tumor stage and preoperative neoadjuvant treatment were identified as independent adverse prognostic factors for OS. However, LAR was not independently associated with OS in the entire cohort. The unadjusted Kaplan–Meier analysis showed that patients in the high-LAR group had poorer OS in the overall cohort and in stage II GC, indicating a potential stage-specific prognostic relevance of LAR. Conclusion: Preoperative LAR was not an independent prognostic factor for overall OS in the GC cohort. However, exploratory analyses suggested potential stage-specific prognostic relevance, particularly in stage II GC. Further large-scale prospective studies are required to validate these findings. Infographic on preoperative LAR and overall survival in gastric cancer with cohort, groups and findings.Infographic: Preoperative lactate dehydrogenase-to-albumin ratio (LAR) and survival in gastric cancer. Study: 568 patients, resected gastric cancer, single-center, retrospective. LAR formula: LDH (U/L) / Albumin (g/L). Groups: Low LAR (n=508) vs. High LAR (n=60). Baseline outcomes: High LAR linked to older age, lower BMI, higher LDH, lower albumin, more lymph node harvest. Analyses: BMI is protective; tumor stage and preoperative neoadjuvant are risk factors. Stage-specific: Stage II and High LAR may have prognostic relevance. Keywords: gastric cancer, LAR, prognosis, risk factors, overall survival