KRAS and neoplasm: Mechanistically, CA19-9-positive tumors often exhibit glycolytic reprogramming driven by KRAS mutations and hypoxia-inducible factor 1-alpha (HIF-1α) activation, which further supports tumor growth, immune evasion, and metastasis (23, 25).Our findings highlight a critical synergy between systemic inflammation (SII) and tumor burden (CA19-9) in determining survival outcomes.