Survival Analysis and Correlates with Molecular Epidemiology: 10-year Retrospective Series of High-Grade Glioma in Pakistan

Abstract

Introduction: High-grade gliomas are malignant, recurring primary CNS tumors requiring extensive postoperative chemotherapy and radiation treatment. Isocitrate dehydrogenase (IDH), 1p19q, and ATRX mutations significantly influence survival and response to chemotherapy, as seen in many extensive studies from the Global North. This study aims to report data from the local region regarding progression-free survival and overall survival in light of molecular characteristics. Materials and Methods: A 10-year retrospective series was conducted at the Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan, with 285 patients presenting from 2008 to 2018. Prospective follow-up data was collected, and complete molecular profiles were available for patients presenting from 2010 onwards. Survival analysis was conducted through the Kaplan-Meier method, with log-rank reported. Results: 70.53% (201) of patients were male, with a mean age at diagnosis of 43.33 ± 15.1 years. 265 patients within the cohort completed postoperative radiotherapy, while 141 patients underwent chemotherapy (PCV [Procarbazine, lomustine and vincristine] or Temozolomide). Mean survival, in months, within the cohort was as follows: glioblastoma (14.1), anaplastic astrocytoma (27.5), and anaplastic oligodendroglioma (39.8). Survival curves showed a lower survival for IDH wild-type (p<0.0001), ATRX mutated (p=0.029), and 1p19q non-deleted (p=0.008) tumors from Pakistan. Discussion: Our findings quantified long-term survival outcomes for high-grade glioma from Pakistan, analysing the various treatment patterns. Of particular importance, molecular sub-classification significantly predicted survival outcomes by IDH, ATRX, and 1p19 co-deletion mutations. Expanding brain tumour epidemiology will benefit assessing the efficacy of regional oncological centres and establishing standards of care.