对一线治疗无反应的晚期胃癌（AGC）对临床管理提出了挑战。本研究的目的是比较阿帕替尼联合S-1二线及以上治疗AGC的疗效和安全性。Cochrane Library、Science Direct、EMBASE、PubMed、CNKI检索截至2023年8月的随机对照试验仅符合《胃癌规范化诊疗指南》的患者纳入研究。提取准确的数据并区分随访时间和药物剂量以减少异质性，并根据Cochrane手册评估纳入试验的偏倚风险。最后，根据试验中的临床反应率、生存期、生化指标和不良事件发生情况来评估治疗的生存获益。荟萃分析包括29项随机对照试验，涉及2149名受试者。临床有效率（优势比 = 2.61，95%置信区间[2.13-3.20]，P < .00001）和疾病控制率（优势比 = 3.16，95%置信区间[2.54-3.94]，P <阿帕替尼与S-1联用时发现了.00001)，并且在降低肿瘤标志物和调节免疫因子方面也具有明显的优势。此外，阿帕替尼联合S-1显着增加了高血压风险，但减轻了肝功能损害，而其他不良事件的改善并不明显。阿帕替尼联合S-1对于二线及以上治疗更有效、更安全AGC的治疗。本研究最大限度地减少了基础数据来源造成的结论偏差，但仍需要更多高质量的研究来验证这些结论。版权所有 © 2024 作者。由 Wolters Kluwer Health, Inc. 出版

Advanced gastric cancer (AGC) that does not respond to first-line therapy poses a challenge to clinical management. The objective of this study was to compare the efficacy and safety of apatinib combined with S-1 in second-line and above treatment of AGC.Cochrane Library, Science Direct, EMBASE, PubMed, and CNKI were searched for randomized controlled trial until August 2023. Only patients who met "Standardized Diagnosis and Treatment Guide for Gastric Cancer" were included in the study. The accurate data and distinguishing between follow-up time and drug dose were extracted to reduce heterogeneity and the risk of bias of the included trials was evaluated according to the Cochrane Handbook. Finally, the survival benefit of the treatment was evaluated based on clinical response rate, survival period, biochemical index, and adverse event occurrence in the trial.The meta-analysis included 29 randomized controlled trials involving 2149 participants. Statistically significant increases in clinical effective rate (odds ratios = 2.61, 95% confidence interval [2.13-3.20], P < .00001) and disease control rate (odds ratios = 3.16, 95% confidence interval [2.54-3.94], P < .00001) were found when apatinib combined with S-1, and also had obvious advantages in reducing tumor markers and regulating immune factors. In addition, apatinib combined with S-1 significantly increased the risk of hypertension but reduced damage to liver function, while the improvement of other adverse events was not pronounced.Apatinib combined with S-1 is more effective and safe for second-line and above treatment of AGC. This study minimized the conclusion bias caused by the basic data sources, but more high-quality studies are still needed to validate these conclusions.Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.