Abstract：
BACKGROUND: For gastric GISTs, neoadjuvant imatinib is most often reserved for tumors near the gastroesophageal junction, multi-visceral involvement, or limited metastatic disease. Whether localized gastric GISTs benefit from neoadjuvant therapy (NAT) remains unknown. We sought to examine factors associated with NAT utilization for localized gastric GISTs and evaluate implications on survival.
METHODS: The National Cancer Database identified patients with localized gastric GISTs treated with NAT (2010-2020), excluding tumors extending beyond the gastric wall, located in the cardia, or with metastatic disease. Multivariable logistic regression assessed characteristics of NAT use. After 1:1 propensity score matching, Kaplan-Meier methods and multivariable Cox regression assessed overall survival (OS).
RESULTS: Of 7,203 patients, 762 (10.6%) received NAT followed by resection. On multivariable analysis, increasing tumor size was associated with NAT use (<2.0cm vs 2.0-5.0cm OR:2.03, 95%CI 1.19-3.47, p=0.010; vs >5cm OR:16.87, 95%CI 10.02-28.40, p<0.001). After propensity score matching, 1,506 patients remained. Median OS for NAT was 46.0 months vs 43.0 months for resection (p=0.059) which was independently predictive of improved survival (HR:0.89; 95%CI 0.80-0.99, p=0.041). Subgroup analysis by tumor size showed no survival differences for tumors <2.0cm or 2.0-5.0cm. Median OS was higher for tumors >5.0cm treated with NAT (NAT:45.4 months [IQR 29.5-65.9]. vs upfront resection:42.3 months [26.9-62.8]) and associated with improved survival on multivariable analysis (HR:0.88; 95%CI 0.78-0.99, p=0.040).
CONCLUSIONS: Although patients who received NAT had improved survival, this was primarily due to tumors >5.0cm. Expanding NAT selection criteria to include localized gastric GISTs >5.0cm may improve outcomes and warrants investigation through clinical trials.
METHODS: The National Cancer Database identified patients with localized gastric GISTs treated with NAT (2010-2020), excluding tumors extending beyond the gastric wall, located in the cardia, or with metastatic disease. Multivariable logistic regression assessed characteristics of NAT use. After 1:1 propensity score matching, Kaplan-Meier methods and multivariable Cox regression assessed overall survival (OS).
RESULTS: Of 7,203 patients, 762 (10.6%) received NAT followed by resection. On multivariable analysis, increasing tumor size was associated with NAT use (<2.0cm vs 2.0-5.0cm OR:2.03, 95%CI 1.19-3.47, p=0.010; vs >5cm OR:16.87, 95%CI 10.02-28.40, p<0.001). After propensity score matching, 1,506 patients remained. Median OS for NAT was 46.0 months vs 43.0 months for resection (p=0.059) which was independently predictive of improved survival (HR:0.89; 95%CI 0.80-0.99, p=0.041). Subgroup analysis by tumor size showed no survival differences for tumors <2.0cm or 2.0-5.0cm. Median OS was higher for tumors >5.0cm treated with NAT (NAT:45.4 months [IQR 29.5-65.9]. vs upfront resection:42.3 months [26.9-62.8]) and associated with improved survival on multivariable analysis (HR:0.88; 95%CI 0.78-0.99, p=0.040).
CONCLUSIONS: Although patients who received NAT had improved survival, this was primarily due to tumors >5.0cm. Expanding NAT selection criteria to include localized gastric GISTs >5.0cm may improve outcomes and warrants investigation through clinical trials.
摘要：
背景：对于胃GIST，新辅助伊马替尼最常用于胃食管交界处附近的肿瘤，多内脏受累，或有限的转移性疾病。局部胃GIST是否受益于新辅助治疗（NAT）尚不清楚。我们试图研究与局部胃GIST的NAT利用相关的因素，并评估对生存的影响。
方法：国家癌症数据库确定了接受NAT治疗的局部胃GIST患者（2010-2020年），排除超出胃壁的肿瘤，位于贲门，或转移性疾病。多变量逻辑回归评估NAT使用的特征。1:1倾向评分匹配后，Kaplan-Meier方法和多变量Cox回归评估总生存期(OS)。
结果：在7,203名患者中，762（10.6％）接受NAT，然后切除。在多变量分析中，肿瘤大小增加与NAT使用相关(<2.0cmvs2.0-5.0cmOR:2.03,95CI1.19-3.47,p=0.010;vs>5cmOR:16.87,95CI10.02-28.40,p<0.001).在倾向得分匹配后，剩下1,506名患者。NAT的中位OS为46.0个月，而切除为43.0个月（p=0.059），这是提高生存率的独立预测因素（HR：0.89；95CI0.80-0.99，p=0.041）。根据肿瘤大小进行的亚组分析显示，<2.0cm或2.0-5.0cm的肿瘤没有生存差异。对于用NAT治疗的>5.0cm的肿瘤，中位OS更高（NAT：45.4个月[IQR29.5-65.9]。与前期切除相比：42.3个月[26.9-62.8]），并与多变量分析的生存率提高相关（HR：0.88；95CI0.78-0.99，p=0.040）。
结论：虽然接受NAT治疗的患者生存率提高，这主要是由于肿瘤>5.0cm。扩大NAT选择标准，包括局部胃GIST>5.0cm可能会改善结果，并保证通过临床试验进行调查。
方法：国家癌症数据库确定了接受NAT治疗的局部胃GIST患者（2010-2020年），排除超出胃壁的肿瘤，位于贲门，或转移性疾病。多变量逻辑回归评估NAT使用的特征。1:1倾向评分匹配后，Kaplan-Meier方法和多变量Cox回归评估总生存期(OS)。
结果：在7,203名患者中，762（10.6％）接受NAT，然后切除。在多变量分析中，肿瘤大小增加与NAT使用相关(<2.0cmvs2.0-5.0cmOR:2.03,95CI1.19-3.47,p=0.010;vs>5cmOR:16.87,95CI10.02-28.40,p<0.001).在倾向得分匹配后，剩下1,506名患者。NAT的中位OS为46.0个月，而切除为43.0个月（p=0.059），这是提高生存率的独立预测因素（HR：0.89；95CI0.80-0.99，p=0.041）。根据肿瘤大小进行的亚组分析显示，<2.0cm或2.0-5.0cm的肿瘤没有生存差异。对于用NAT治疗的>5.0cm的肿瘤，中位OS更高（NAT：45.4个月[IQR29.5-65.9]。与前期切除相比：42.3个月[26.9-62.8]），并与多变量分析的生存率提高相关（HR：0.88；95CI0.78-0.99，p=0.040）。
结论：虽然接受NAT治疗的患者生存率提高，这主要是由于肿瘤>5.0cm。扩大NAT选择标准，包括局部胃GIST>5.0cm可能会改善结果，并保证通过临床试验进行调查。
