Brainlab Neurosurgery Award - Glioma Surgical Outcomes Study [AGOS]: Survival and Time-trend Analysis of Surgically Treated Gliomas over a Decade in an LMIC

Introduction: The Aga Khan University Glioma Surgical Outcomes study seeks to address disparities in the availability of information regarding glioma outcomes, prognostic factors, and variance in hospital-based metrics over a ten-year period in our population.

Methods: Demographic and outcomes data for 1104 glioma patients were accrued for a 10-year period, from January 2010 to December 2019, at our center. Survival data were correlated with demographic, surgical, tumor, and treatment characteristics. Cox proportional hazard models and Kaplan Meier curves demonstrated survival and prognostic factors, while logistic and binary regression models identified correlations.

Results: In a ten-year period, 1104 patients with a mean age of 35.94 ± 19.62 years presented at our center. The male patients (66%) had a significant survival benefit with gross total resection (GTR) (HR= 0.332, p= 0.045, CI= 0.113, 0.976). The majority (29%) of patients were glioblastoma multiforme and had a significantly higher risk of early mortality than other tumor types (HR=4.955, p=0.000, CI= 2.884, 8.514). Both age (HR=3.482, p=0.014, CI= 1.292, 9.389) and length of stay (HR=3.482, p=0.014, CI= 1.292, 9.389) were positively correlated with early mortality. The overall proportion of high-grade tumors decreased from 71% to 60% over time, and low-grade tumors increased from 29% to 40%, while annual GBM volume increased by 82.6% over the past five years.

Conclusion : Our data provides level 2 evidence for several prognostic factors for glioma patients within our population that need to be addressed to improve healthcare provision, not only within our center, but regional hospitals at large.