Abstract: Objective To assess the relationship between cancer related anemia (CRA) and prognosis in patients with advanced gastric cancer who were treated by Epirubicin Oxaliplatin and Xeloda as first-line chemotherapy. Methods Clinical data about 58 patients diagnosed with advanced gastric cancer who underwent first-line chemotherapy of EOX regimen at least 2 cycles in our hospital from 2012 to 2013 were retrospectively analyzed. According to the level of hemoglobin before and during treatment period, the patients were divided into two groups:anemia group (A1) and the absent group (A0).The relationship between CRA and clinical outcome of these two groups were analyzed. Results The median PFS and OS in group A1 were significantly lower than group A0 (5.3 vs 7.2 m, P=0.032; 13.6 vs 17.1 m, P=0.027). The multivariate Cox analysis showed that the adjusted hazard ratio (HR) of PFS in anemia group was 25% lower than group A0 (HR 0.75, 95% CI:0.413-0.914, P=0.018). The mortality risk of OS was 26% lower than group A0 (HR 0.74, 95% CI:0.452-0.921, P=0.032). Conclusion The anemia patients are likely to have a shorter PFS and OS compared with normal patients. The cancer related anemia is an independent prognostic factor. Prospective trials are required to validate those findings.