ArticleAnnals of surgical oncology2026
Pre-progression Surgery Added to Imatinib is Associated with Prolonged Survival in Oligometastatic GIST: A Covariate-Matched Study.
Article in Annals of surgical oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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6 authors.
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Abstract
backgroundThe role and optimal timing of surgery in oligometastatic gastrointestinal stromal tumors (GIST) remain controversial. We evaluated whether pre‑progression surgery added to first‑line imatinib improves survival in oligometastatic GIST.
methodsWe retrospectively analyzed 179 patients with metastatic/recurrent GIST treated with first‑line imatinib. Oligometastasis was defined as ≤ 3 lesions and ≤ 2 organs. Covariate matching (1:1 nearest-neighbor matching on covariates, caliper = 0.05) was performed among oligometastatic patients receiving imatinib alone (Group A) versus imatinib plus pre‑progression surgery (Group B1). Outcomes were compared by using Kaplan‑Meier, log‑rank/Gehan-Breslow-Wilcox, restricted mean survival time (RMST), and Cox regression.
resultsAmong 179 patients, 90 (50.3%) had oligometastasis. In the imatinib‑alone subgroup, oligometastatic and polymetastatic patients had similar survival (PFS: P = 0.693; overall survival [OS]: P = 0.237). After matching (29 pairs), pre-progression surgery was associated with significantly prolonged OS (HR = 0.16, P = 0.007) and provided clinically meaningful PFS benefit (median 104 vs. 29 months; HR = 0.48; log-rank P = 0.041). Restricted mean survival time analysis at 120 months showed additional 32.97 months of PFS (P = 0.007) and 30.88 months of OS (P = 0.003). These findings were robust across all sensitivity analyses.
conclusionsPre-progression surgery added to first-line imatinib was associated with significantly prolonged OS and provides clinically meaningful PFS benefit in oligometastatic GIST. Surgical evaluation should be actively considered in imatinib‑sensitive oligometastatic disease.
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