To compare the efficacy and safety of S-1 plus oxaliplatin (SOX therapy) with S-1 plus cisplatin (SP therapy) for patients with advanced gastric cancer (AGC).

Databases such as PubMed, Embase, Web of Science, CNKI, Chinese Biomedical Literature Database, Wanfang Data, VIP were searched from the inception to July 2022. Relevant studies were retrieved on the controlled study of S-1 plus oxaliplatin (SOX group) or S-1 plus cisplatin (SP group) for AGC. Quality of the included studies was assessed by the Cochrane Handbook 5.1 tool. Meta-analysis was performed using RevMan 5.4 software.

A total of 14 literatures involving 2 650 patients with AGC were included, with 1 334 patients in the SOX group and 1 316 patients in the SP group. The overall survival (HR=0.87, 95% CI: 0.78-0.97, P=0.01), progression-free survival (HR=0.87, 95% CI: 0.78-0.97, P=0.01), complete response (OR=1.43, 95% CI: 1.02-2.00, P=0.04), partial response (OR=1.64, 95% CI: 1.18-2.29, P=0.003), progress disease (OR=0.55, 95% CI: 0.34-0.87, P=0.01), disease control rate (OR=1.64, 95% CI: 1.04-2.56, P=0.03), and disease stability (OR=0.67, 95% CI: 0.53-0.83, P=0.000 4) in the SOX group were significantly better than those in the SP group. However, there was no statistically significant difference in objective response rate between the two groups (OR=1.57, 95% CI: 0.85-2.90, P=0.15). In terms of safety, the incidence of grade 3 or higher adverse reactions of SOX group was lower in leukopenia (OR=0.20, 95% CI: 0.13-0.30, P<0.000 01), anemia (OR=0.52, 95% CI: 0.32-0.86, P=0.01), creatinine elevation (OR=0.21, 95% CI: 0.07-0.61, P=0.004), but higher than SP group in peripheral sensory neuropathy (OR=10.64, 95% CI: 1.85-61.10, P=0.008).

SOX therapy can improve the treatment efficiency, progression-free survival and overall survival of AGC, but may increase the incidence of peripheral sensory neuropathy.