Comparison of therapeutic efficacy between transarterial infusion chemotherapy and systemic chemotherapy in advanced gastric cancer

The optimal neoadjuvant or conversion therapy for advanced gastric cancer remains controversial. While systemic chemotherapy (SC) is the standard, transarterial infusion chemotherapy (TAI) delivers chemotherapeutic agents directly to the tumor-feeding arteries, potentially enhancing local efficacy and reducing systemic toxicity. A systematic search of electronic databases (PubMed, Embase, Cochrane Library, Web of Science and CNKI) was conducted for studies published from inception to November 1, 2025. Statistical heterogeneity was assessed using the I 2 statistic and the Cochran’s Q test (with a significance level of P < 0.1). High heterogeneity was considered when I 2 > 50%, in which case a random-effects model was applied. For studies with I 2 ≤ 50%, a fixed-effects model was used, and a P -value < 0.05 was considered statistically significant. All analyses were performed using Stata software (version 18.0). Six studies, encompassing a total of 893 patients (TAI: n = 468; SC: n = 425), were included in the final analysis. Four of the six included studies reported overall survival data. The pooled result demonstrated that TAI was associated with a significantly reduced risk of death compared to the control group (HR = 0.64, 95% confidence interval (CI): 0.52–0.79, p < 0.001). Six studies compared objective response rate (ORR) between two groups. The result indicated that the ORR of the TAI group was significantly higher than that of the SC group, (RR = 1.59, 95% CI: 1.25, 2.01, p < 0.001). This article suggests that interventional therapy, such as TAI, offers a survival advantage over SC for gastric cancer patients and is associated with a high ORR. These findings suggests that TAI may represent a promising therapeutic approach, although the conclusions should be interpreted cautiously given the limited number of included studies.