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March 13, 2026Open Access

Impact of neoadjuvant imatinib duration and tumor response on recurrence-free survival in locally advanced gastrointestinal stromal tumors: a retrospective multicenter cohort study

Puntos clave

This study aims to determine the impact of neoadjuvant imatinib duration and tumor response on recurrence-free survival in locally advanced gastrointestinal stromal tumors.
Conducted a multicenter retrospective cohort study at four centers in China.
Assessed tumor response using RECIST 1.1 and introduced the Percent Tumor Response Index (PTRI).
Analyzed recurrence-free survival (RFS) and overall survival (OS) using Kaplan–Meier and Cox regression methods.
Examined clinical outcomes of 168 patients treated with preoperative imatinib.
All patients achieved disease control with 52.4% showing partial response and 47.6% stable disease.
Median tumor size decreased significantly from 10.0 to 7.0 cm (p < 0.001).
3- and 5-year RFS rates were 88.6% and 83.2%, while OS rates were 97.6% and 92.0%.
Patients treated for ≤ 8 months had better RFS outcomes compared to those treated for > 8 months.
Higher PTRI scores were linked to a 32% reduced risk of recurrence per unit increase.

Resumen

Neoadjuvant imatinib (IM) is widely used in locally advanced gastrointestinal stromal tumors (GISTs) to improve resectability and reduce recurrence, but optimal duration and the prognostic role of tumor response remain unclear. We performed a multicenter retrospective cohort study of patients with locally advanced GISTs who received preoperative imatinib and surgery between 2014 and 2024 at four tertiary centers in China. Tumor response was assessed by Response Evaluation Criteria in Solid Tumors (RECIST) 1.1, and a novel parameter, the Percent Tumor Response Index (PTRI), was proposed to integrate baseline size with shrinkage rate. Recurrence-free survival (RFS) and overall survival (OS) were analyzed by Kaplan–Meier and Cox regression. Among 168 patients (median treatment 7.5 months), all achieved disease control: partial response (PR) in 52.4% and stable disease (SD) in 47.6%. Median tumor size decreased from 10.0 to 7.0 cm (p 8 months. In multivariable Cox regression analysis, a preoperative imatinib duration exceeding 8 months (HR 2.40, p = 0.034) and a postoperative mitotic count > 5/5 HPF (HR 2.31, p = 0.042) were independently associated with worse RFS, whereas a higher Percent Tumor Response Index (PTRI), a newly proposed exploratory metric, was associated with a reduced risk of recurrence, corresponding to a 32% risk reduction per unit increase (p = 0.002). In our cohort, a preoperative imatinib duration exceeding 8 months for locally advanced GISTs was associated with inferior RFS. Elevated PTRI predicted favorable recurrence outcomes, whereas higher postoperative mitotic count indicated poorer prognosis.

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