Objective To analyze the therapeutic efficacy of low-dose apatinib combined with first-line chemotherapy in the conversion therapy of advanced gastric cancer.Methods A total of 158 patients with advanced gastric cancer admitted to our hospital from February 2018 to January 2020 were randomly divided into control group and study group, with 79 cases in each group. The control group was given oxaliplatin and Tegafur/Gimeracil/Oteracil, and the study group was additionally given apatinib. Both groups received 6 courses of conversion therapy and were followed up for 1 year. The anti-tumor efficacy, the changes of tumor markers and the occurrence of adverse drug reactions were compared between the two groups. The surgical outcome and 1-year survival of the two groups were compared.Results Nine cases were lost to the follow-up during the treatment period. The objective response rate and disease control rate of the study group were higher than those of the control group (P < 0.05). The differences of proliferating cell nuclear antigen (PCNA), cyclooxygenase-2 (COX-2) and vascular endothelial growth factor (VEGF) before and after the treatment in the study group were higher than those in the control group (P < 0.05). There were no significant differences in the incidence of leukopenia, neutropenia, fatigue, anemia, hand-foot syndrome, proteinuria, stomatitis and elevated blood pressure between two groups during the treatment (P > 0.05). The R0 resection rate of the study group was higher than that of the control group (P < 0.05). Besides, the 1-year overall survival rate of the study group was higher than that of the control group (P < 0.05).Conclusions Low-dose apatinib combined with first-line chemotherapy as the conversion therapy for advanced gastric cancer can enhance anti-tumor efficacy, reduce the levels of tumor markers, and improve R0 resection rate and short-term survival rate with few safety concerns.