Prognostic value of the preoperative lactate dehydrogenase-to-albumin ratio in patients with gastrointestinal cancer.

Abstract

Gastrointestinal cancer (GIC) remains a major clinical burden, and readily available biomarkers are needed to improve preoperative prognostic assessment and risk stratification. The present study aimed to evaluate the prognostic significance of the preoperative lactate dehydrogenase-to-albumin ratio (LAR) in patients with GIC. A comprehensive search was performed in PubMed, Embase and the Cochrane Library to identify relevant studies published from the date of database inception to March 20, 2025. The extracted outcomes included hazard ratios (HRs) for overall survival (OS) and recurrence-free survival (RFS) and odds ratios (ORs) for major postoperative complications. A total of five independent studies involving 6,379 patients were included in the present meta-analysis. A higher preoperative LAR was significantly associated with poorer OS [HR=1.90; 95% confidence interval (CI), 1.63-2.21; P<0.001]. Subgroup analysis confirmed the robustness of this association across analytical models, cancer types, countries and LAR cut-off values. A higher LAR was also associated with poorer RFS (HR=1.83; 95% CI, 1.52-2.20; P<0.001) and a higher risk of major postoperative complications (OR=2.36; 95% CI, 1.49-3.74; P<0.001). In conclusion, preoperative LAR may serve as a useful prognostic biomarker for survival outcomes in patients with GIC. Incorporating this readily available and low-cost biomarker into routine preoperative assessment may help improve perioperative risk stratification and guide postoperative management.