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. 2025 Aug;29(8):102117.
doi: 10.1016/j.gassur.2025.102117. Epub 2025 Jun 16.

Trends and outcomes for patients receiving neoadjuvant therapy for stage I to III gastric gastrointestinal stromal tumors

Cade F Bennett  1 , Lauren M Janczewski  2 , Dominic Vitello  2 , Amy Wells  1 , Farres Obeidin  3 , Borislav A Alexiev  3 , John Hayes  4 , Fahad Faruqi  5 , David Bentrem  6 , Jeffrey D Wayne  7 , John Abad  1 , Ashley Hardy  1 , Pedro Hermida de Viverios  8 , Seth M Pollack  8 , Akhil Chawla  9
Affiliations

Trends and outcomes for patients receiving neoadjuvant therapy for stage I to III gastric gastrointestinal stromal tumors

Cade F Bennett et al. J Gastrointest Surg. 2025 Aug.

Abstract

Background: The use of neoadjuvant therapy (NAT) is not well characterized across the entire spectrum of localized gastrointestinal stromal tumors (GISTs). This study aimed to identify treatment trends for the use of NAT and survival outcomes in patients who underwent surgery for gastric GISTs.

Methods: The National Cancer Database was queried to identify patients with stage I to III gastric GISTs between 2006 and 2020 who underwent curative-intent surgery after NAT or upfront surgery (UFS). The cohort demographics and cancer characteristics were compared using analysis of variance, generalized linear models, and chi-square analysis. Treatment trends were assessed using linear regression. Cox proportional hazards models and Kaplan-Meier curves were used for propensity score matching (3:1).

Results: Between 2006 and 2020, 1504 patients (8.1%) received NAT, followed by surgery, and 17,150 patients (91.9%) received UFS with curative intent. The cohort analysis revealed that, compared with patients who underwent UFS, those who underwent NAT had higher grade tumors (P =.031), larger tumors (12.0 vs 6.4 cm, respectively; P <.001), and higher clinical staging (P <.01). Linear regression indicated that the use of NAT became more common each year (0.88%; P <.05) and that NAT was administered for longer durations before surgery (increase in 5.5 d/y; SE, 0.9; P <.05). Despite NAT being used for larger and higher-grade tumors, patients who underwent NAT had similar outcomes as those who underwent UFS (UFS: hazard ratio, 0.86 [95% CI, 0.76-1.01]; P =.07).

Conclusion: Our results demonstrate that the use of NAT has been increasing over time and that NAT is used for more advanced gastric GISTs. Although NAT is used for higher-risk tumors, its use for gastric GISTs leads to similar outcomes as UFS.

Keywords: Gastric; Gastrointestinal stromal tumor; National Cancer Database; Neoadjuvant therapy; Surgical oncology.

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