<p>Main findings of the included studies.</p>

Six symptom assessment tools were identified, with the Chinese version of the MD Anderson Symptom Inventory–Gastrointestinal Cancer Module (MDASI-GI-C) being the most frequently used tool (reported in 7 studies). Nine core symptoms were identified across the included studies, with fatigue being the most frequently reported core symptom (identified in 5 studies). Ten bridge symptoms were identified; however, considerable variation was observed in the identification of bridge symptoms across studies.

Longitudinal analyses suggested that phlegm-dampness constitution was associated with subsequent changes in taste, while changes in taste were associated with subsequent appetite loss.</p> <p>Conclusions</p><p>The symptom profiles of patients with gastric cancer are characterized by complexity, dynamic changes across treatment stages, and population heterogeneity. Symptom management strategies may benefit from individualized and stage-specific approaches targeting core symptoms, bridge symptoms, and key symptom pathways.

Future research should focus on standardizing symptom assessment tools and assessment time points, conducting multicenter longitudinal studies, and supporting the development and evaluation of interventions for clinical practice.</p> <p>Trial registration</p><p>OSF Registration DOI: <a href="doi.org/10.17605/OSF.IO/MJAZ3" target="_blank">doi.org/10.17605/OSF.IO/MJAZ3</a></p></div>