Aim To assess the clinical efficacy and safety of S-1 combined with paclitaxel(PTX)for advanced gastric cancer(AGC)by performing a systematic review and meta-analysis of the published studies.Methods All published randomized controlled trials(RCTs)of S-1 combined with PTX for AGC were searched.Studies that included patients with locally advanced or metastases gastric cancers were included.We searched the databases included Cochrane Library of Clinical Comparative Trials,MEDLINE,Embase,American Society of Clinical Oncology meeting abstracts and China National Knowledge Internet(CNKI)from 2000 to 2016.The censor date was up to January 2016.The first endpoint was overall survival(OS).Other endpoints were progression-free survival(PFS),objective response rate(ORR)and disease control rate(DCR).Safety analyses were also performed.All calculations and statistical tests were performed using Stata 12.0 software.Results A total of 1407 patients with AGC enrolled in 7 trials were divided into study group(n =711)and control group(n =696).S-1 combined with PTX significantly improved the OS [HR = 0.78,95%CI: 0.60-0.97,P = 0.000],PFS [HR = 0.70,95%CI: 0.55-0.85,P = 0.000],ORR [RR = 1.30,95%CI: 1.05-1.60,P = 0.017] and DCR [RR = 1.15,95%CI: 1.04-1.27,P = 0.008] of patients with AGC.The grade 3 or 4 hematological and non-hematologic toxicities were anemia [RR = 1.71,95%CI: 1.04-2.79,P = 0.03],neutropenia [RR = 1.65,95%CI: 1.32-2.06,P < 0.0001] and anorexia [RR = 1.66,95%CI: 1.05-2.64,P = 0.03].Conclusion S-1 combined with PTX may be a good choice for patients with AGC,at least in Asia because of good efficacy and rather better safety.