Determinants of poor prognosis after surgery for glioblastoma: A retrospective analysis of predictors of morbidity and mortality in a low-middle income country.

Background & Objective: High-grade gliomas (HGG) and glioblastomas are the most prevalent types of primary brain tumors. Despite aggressive treatment, recurrence is almost inevitable with significantly poor prognosis. We aimed to determine the factors associated with morbidity and mortality in patients with glioblastoma after surgical excision. Methodology: In this retrospective observational study, data regarding patient demographics, clinical features, tumor characteristics and treatment outcomes was recorded for all patients who underwent glioblastoma multiform tumor excision surgery at Punjab Institute of Neurosciences between 2022 and 2024. Multiple predictor variables were identified using univariate and multivariate analysis. The relationship between overall survival and predictor variables was presented in the form of Kaplan Meir survival curves. Data was analyzed using SPSS version 29. Results: The mean age of study participants was 47.0±15.8 years with 82% (41) males. The mean preoperative Glasgow coma scale (GCS) and Karnofsky Performance Status (KPS) was 13.2±2.8 and 65.2±17.6 respectively. The medial overall survival was 381.5 days. Obesity, tumor origin, preoperative and post-operative GCS and KPS score, and extent of resection were identified as significant predictor variables using univariate analysis (p<0.05). On multivariate analysis, extent of resection was a significant positive predictor of survival, HR=0.041 (95% CI: [0.003-0.581]). Conclusion: Majority of gliomas undergo gross total resection and had a median survival of one year. Extent of resection is a significant independent predictor of survival in glioblastomas, where gross total resection is associated with a lower risk of mortality.