To explore the clinical and pathological characteristics, treatment strategies, and outcomes of patients with locally advanced gastric cancer receiving neoadjuvant therapy. Methods    A retrospective analysis was conducted on the data of patients with locally advanced gastric cancer (cT1-2N+M0 or cT3-4bNxM0) who received neoadjuvant therapy and underwent surgical resection at 22 hospitals, between January 2018 and December 2023. All patients completed at least one cycle of neoadjuvant therapy prior to surgery. Results    A total of 3,892 patients were included in this study, including 2,945 males (75.7%) and 947 females (24.3%). The initial diagnosis age of patients was mainly concentrated in the age groups of 65-＜70 years (871 cases, 22.4%), 60-＜65 years (724 cases, 18.6%), and 55-＜60 years (640 cases, 16.4%). Among all patients, 2,460 (63.2%) received neoadjuvant chemotherapy, 1,173 (30.1%) received neoadjuvant chemotherapy combined with immunotherapy. The commonly used chemotherapy regimens in neoadjuvant treatment were SOX regimen (1,771 cases, 45.6%), FLOT4 regimen (470 cases, 12.1%), and XELOX regimen (412 cases, 10.6%). The commonly used immunotherapeutic agents were sintilimab (577 cases, 45.1%), tislelizumab (175 cases, 13.7%), and toripalimab (123 cases, 9.6%). The common number of cycles for neoadjuvant chemotherapy were three cycles (1,478 cases, 38.0%), four cycles (1,083 cases, 27.9%), and two cycles (866 cases, 22.3%); while for neoadjuvant immunotherapy, the common number of cycles were three cycles (548 cases, 42.9%), four cycles (317 cases, 24.8%), and two cycles (245 cases, 19.2%). The R0 resection rate for the entire cohort was 98.4%, with 494 cases achieving pathological complete response (pCR) and 1,053 cases achieving major pathological response (MPR). The group receiving neoadjuvant chemotherapy combined with immunotherapy had significantly higher R0 resection rate (99.2% vs. 97.8%, P=0.05), pCR rate  (21.6% vs. 9.5%, P<0.01), and MPR rate  (39.8% vs. 23.6%, P<0.01) compared to the group receiving neoadjuvant chemotherapy alone. The incidence rates of adverse reactions were 21.9% in the neoadjuvant chemotherapy group and 24.6% in the neoadjuvant chemotherapy combined with immunotherapy group (P=0.12), and the incidence rates of postoperative complications were 20.6% and 24.4%, respectively (P=0.34), with no statistically significant differences between the two groups. Conclusion    In China, the proportion of neoadjuvant chemotherapy combined with immunotherapy shows a progressive upward trend in managing locally advanced gastric cancer. Compared with single neoadjuvant chemotherapy, the combination of chemotherapy and immunotherapy has shown higher R0 resection rate and pathological response rate, without increasing the incidence of adverse reactions and compromising surgical safety.