To our knowledge, this study is the first to evaluate the cost-effectiveness of nivolumab plus chemotherapy as first-line treatment for advanced PD-L1 CPS ≥5 GC/GEJC/esophageal adenocarcinoma patients as recommended by the latest clinical guidelines (7), and our results are of great significance in both China and other countries. Here, CD274 is linked to esophageal adenocarcinoma.