The expression of PD-L1 alone has shown limited reliability for predicting immunotherapy effectiveness in GC, particularly in low mutational burden tumors [17]. This is supported by Pietrantonio et al.’s meta-analysis of randomized clinical trials, including KEYNOTE-062, CheckMate-649, JAVELIN Gastric 100, and KEYSTONE-061, demonstrating worse survival outcomes in patients with low microsatellite instability treated with anti-PD-L1-based treatment compared to patients with high microsatellite instability [18]. Here, CD274 is linked to gastric cancer.