Utilization of Neoadjuvant Therapy in Gastrointestinal Stromal Tumors of the Stomach: Analysis of the 2006–2018 National Cancer Database

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Journal of Gastrointestinal Surgery


Background: Neoadjuvant tyrosine kinase inhibitor (TKI) therapy has reduced tumor burden and improved survival in both primary and recurrent gastrointestinal stromal tumors (GISTs). However, no clear guidelines exist on optimal patient selection for neoadjuvant therapy (NAT). Our aim was to analyze factors and outcomes associated with the therapeutic sequence of TKI therapy before and/or after surgery for gastric GISTs. Methods: We performed a retrospective study of patients surgically treated for a gastric GIST utilizing the 2006–2018 National Cancer Database. We examined demographic, clinical, and pathological characteristics associated with NAT versus adjuvant therapy (AT) using logistic regression. Results: Of the 3732 patients, 20.4% received NAT and 79.6% had AT. Among patients receiving therapy, NAT significantly increased over our study period (12% to 30.7%). A majority of the AT group received a partial gastrectomy (77.9%) compared with the NAT group who received more near-total/total gastrectomy or gastrectomy with en bloc resection (p < 0.001). In a multivariable model, patients were more likely to receive NAT when insured (private, aOR: 2.37, 95% CI: 1.31–4.29), treated at an academic/research program (aOR: 1.83, 95% CI: 1.49–2.56), had tumors located in the proximal stomach (aOR: 1.40, 95% CI: 1.06–1.86), tumor size > 10 cm (aOR: 1.88, 95% CI: 1.41–2.51), and received near-total/total gastrectomy (aOR: 1.81, 95% CI: 1.42–2.29). There were no differences in outcomes. Conclusion: NAT for gastric GIST has increased in utilization. NAT was used in patients with larger tumors and who underwent more extensive resection. Despite these factors, outcomes were similar to patients receiving only AT. More studies are required to determine the therapeutic sequence for gastric GISTs.