Management and prognostic outcomes of gastrointestinal stromal tumors in Sub-Saharan Africa: the central role of surgery in resource-limited settings: a systematic review and meta-analysis (2014-2024).

backgroundGastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the digestive tract. However, data from Sub-Saharan Africa (SSA) remain fragmented, and no prior systematic review has synthesized regional diagnostic and treatment practices.

methodsWe conducted a systematic review and meta-analysis following PRISMA 2020 guidelines (PROSPERO: CRD42024575650). PubMed, Embase, Scopus, Google Scholar, and African Journals Online were searched for studies published between January 2014 and June 2024. Eligible population-, community-, and hospital-based studies reporting on GIST management or prognosis in SSA were included. Study quality was assessed using Joanna Briggs Institute tools. Random-effects models (REML with Hartung-Knapp adjustment) were used to estimate pooled outcomes.

resultsTwenty-one studies comprising 410 patients met inclusion criteria. The median age ranged from 52 to 56 years, and the male-to-female ratio was approximately 1.3:1. The stomach was the most frequent tumor site (64.1%), followed by the small intestine (14.6%). Most patients were symptomatic at diagnosis, with abdominal pain (50.4%) and abdominal mass (47.3%) being the predominant complaints. Computed tomography was the primary imaging modality (99.5%). Surgery was performed in 70% of patients, with R0 resection achieved in 68.2%. Imatinib was used as neoadjuvant (n = 58), adjuvant (n = 64), or palliative therapy (n = 75). Among 199 evaluable patients, the pooled disease-control rate was 77.3% (CR: 32.5%; PR: 27.9%; SD: 7.9%), while progressive disease occurred in 18.9%. The pooled median overall survival was 44.0 months. Postoperative mortality was 0.7%, and overall mortality during follow-up was 9.8%.

conclusionThis review provides the first comprehensive synthesis of GIST management in Sub-Saharan Africa. Despite limited diagnostic infrastructure and late presentations, therapeutic outcomes particularly disease control with imatinib and low postoperative mortality appear numerically comparable in selected settings where treatment is accessible, although structural and methodological disparities preclude direct equivalence. Strengthening early detection, expanding immunohistochemistry and molecular testing, and improving access to tyrosine kinase inhibitors remain critical for improving survival in the region.