Neoadjuvant chemotherapy in resectable gastric cancer: An international propensity-matched analysis of 23,805 patients from high-volume centers across three continents.

413 Background: The role of neoadjuvant chemotherapy (NAC) in resectable, locally advanced gastric cancer is debated, with wide variation in adoption between Asian and Western countries. The impact of these diverse practices on perioperative and long-term outcomes is not well defined. Methods: We analyzed 23,805 patients who underwent resection from 10 high-volume gastric cancer centers across Asia, Europe and North America from January 3, 2005 to March 11, 2024. Patients with ≥T2 tumors undergoing radical gastrectomy with or without NAC were compared. Propensity score matching (3:1) adjusted for age, comorbidity, clinical stage, and histology. Results: After matching 1,017 patients (353 NAC, 664 non-NAC) were evaluated. In the West FLOT was the most common regimen (56.3%), while the East had more variability but overall used a combination of taxane and platinum agent (63.5%), with SOX being most common (17.9%). NAC patients more often underwent total gastrectomy (31.2% vs 23.5%, p