Gastric cancer patients with peritoneal metastasis can achieve better outcomes through informed conversion therapy decisions.

• Study found a 19.4% rate of R0 resection in patients who underwent conversion therapy.
• Patients receiving conversion surgery had significantly longer median overall survival (p<0.001).
• High CA125 levels increase the risk of conversion therapy failure (OR: 5.449, p=0.01).

For those with normal CA125 levels, consider early aggressive treatment paired with PD-1 inhibitors to improve chances of successful conversion therapy.