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CC BY-NC-ND 4.0 · Asian J Neurosurg 2022; 17(02): 178-188
DOI: 10.1055/s-0042-1750779
Original Article

Comparison of Glioblastoma Outcomes in Two Geographically and Ethnically Distinct Patient Populations in Disparate Health Care Systems

Farhan A. Mirza
1   Department of Neurosurgery, Kentucky Neuroscience Institute (KNI), University of Kentucky, Lexington, Kentucky, United States
2   Department of Neurosurgery, The Montreal Neurological Institute (MNI), McGill University, Montreal, QC, Canada
,
Muhammad Waqas S. Baqai
3   Department of Surgery, Section of Neurosurgery, Aga Khan University Hospital, Karachi, Pakistan
,
Ummey Hani
3   Department of Surgery, Section of Neurosurgery, Aga Khan University Hospital, Karachi, Pakistan
,
Maher Hulou
1   Department of Neurosurgery, Kentucky Neuroscience Institute (KNI), University of Kentucky, Lexington, Kentucky, United States
,
Muhammad Shahzad Shamim
3   Department of Surgery, Section of Neurosurgery, Aga Khan University Hospital, Karachi, Pakistan
,
Syed Ather Enam
3   Department of Surgery, Section of Neurosurgery, Aga Khan University Hospital, Karachi, Pakistan
,
Thomas Pittman
1   Department of Neurosurgery, Kentucky Neuroscience Institute (KNI), University of Kentucky, Lexington, Kentucky, United States
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Abstract

Introduction Variations in glioblastoma (GBM) outcomes between geographically and ethnically distinct patient populations has been rarely studied. To explore the possible similarities and differences, we performed a comparative analysis of GBM patients at the University of Kentucky (UK) in the United States and the Aga Khan University Hospital (AKUH) in Pakistan.

Methods A retrospective review was conducted of consecutive patients who underwent surgery for GBM between January 2013 and December 2016 at UK, and July 2014 and December 2017 at AKUH. Patients with recurrent or multifocal disease on presentation and those who underwent only a biopsy were excluded. SPSS (v.25 IBM, Armonk, New York, United States) was used to collect and analyze data.

Results Eighty-six patients at UK (mean age: 58.8 years; 37 [43%] < 60 years and 49 [57%] > 60 years) and 38 patients at AKUH (mean age: 49.1 years; 30 (79%) < 60 years and 8 (21%) > 60 years) with confirmed GBM were studied. At UK, median overall survival (OS) was 11.5 (95% confidence interval [CI]: 8.9–14) months, while at AKUH, median OS was 18 (95% CI: 13.9–22) months (p = 0.002). With gross-total resection (GTR), median OS at UK was 16 (95% CI: 9.5–22.4) months, whereas at AKUH, it was 24 (95% CI: 17.6–30.3) months (p = 0.011).

Conclusion Median OS at UK was consistent with U.S. data but was noted to be longer at AKUH, likely due to a younger patient cohort and higher preoperative Karnofsky's performance scale (KPS). GTR, particularly in patients younger than 60 years of age and a higher preoperative KPS had a significant positive impact on OS and progression-free survival (PFS) at both institutions.

Keywords

glioma - glioblastoma - survival - population heterogeneity - health care system - Pakistan

Note

Portions of this manuscript were presented in poster format at the 2019 Congress of Neurological Surgeons (CNS) meeting held in San Francisco, California, United States of America, in October 19-23, 2019.


Authors' Contributions

F.A.M. contributed to the study conceptualization, data collection and analysis, literature review, developing and finalizing themanuscript, approval of the final manuscript M.W.S.B. contributed to data collection and analysis and manuscript development. U.H. contributed to data collection and analysis and manuscript development. M.M.H. contributed to data collection and analysis and manuscript development. M.S.S. contributed to the study supervision and conceptualization, manuscript development, and approval of the final manuscript. S.A.E. contributed to the study supervision and approval of the final manuscript. T.P. contributed to the study supervision and conceptualization, approval of the final manuscript.




Publication History

Article published online:
24 August 2022

© 2022. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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