Conclusion
We regard advanced gastric cancer as a systemic disease. Meaningful prognostic criteria are intraperitoneal and local recurrence. Neoadjuvant CTx succeeds in reducing local relapse, but does not appear to impact the overall survival. Despite this lack of benefit as seen across all tumor stages, a subgroup of patients with stage III tumors seems to benefit significantly from neoadjuvant CTx. However, it remains challenging to select these patients due to the low accuracy of current diagnostics. In summary, additional therapeutic modalities, such as antibody treatment in combination with current standards of treatment will be necessary to improve the prognosis of advanced gastric cancer.