Quality of life and outcomes of patients operated on for glioblastoma at the Yaoundé General Hospital

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This study aimed to describe the diagnostic aspects, therapeutic strategies, quality of life and outcomes of patients operated on for glioblastoma at the Yaoundé General Hospital. Methods: This was a descriptive cross-sectional study conducted at the Yaoundé General Hospital. Included were 32 patients who underwent surgery for glioblastoma with histological evidence from January 2019 to June 2025. Data were collected from medical records and analyzed using SPSS version 25. Quality of life was assessed using the Karnofsky and EORTC QLQ-C30 scores. Factors associated with the quality of life and outcomes where identified and a P value < 0.05 was considered significant. Results: Thirty-two patients were included, with a median age of 47.50 years [17.75 ;59.75], mean age of 42.9 ± 13.8 years and a female predominance (65.6%). The most common presenting symptom was neurologic deficit (68.8%). MRI was the main diagnostic modality (59.4%), and the tumor was most often located in the temporal lobe (30.8%). Surgery alone was performed in 56.3% of cases, while 25% received surgery followed by radiochemotherapy. The average overall survival was 10.2 months, increasing to 13.4 months in patients who received the full multimodal treatment. Quality of life scores were also better in this group. Age greater than 60 was found to be significantly associated with poor outcome. Conclusion: Glioblastoma affects all ages in our setting. Combined therapeutic strategies, especially the addition of radiochemotherapy after surgery, were associated with longer survival and better quality of life. Multidisciplinary management remains essential to improve outcomes. Neurology Oncology Neurosurgery glioblastoma quality of life survival Yaoundé General Hospital Figures Figure 1 Figure 2 Figure 3 Figure 4 INTRODUCTION Glioblastoma multiforme (GBM) is the most common and most aggressive primary malignant brain tumor in adults, accounting for approximately 15% of all primary intracranial neoplasms and nearly 50% of gliomas worldwide [ 1 , 2 ]. According to recent estimates, the global incidence of GBM ranges from 3.2 to 4.7 per 100,000 population per year, with higher rates reported in Western countries [ 3 – 5 ]. In Sub-Saharan Africa, accurate epidemiological data are scarce due to underdiagnosis, delayed imaging, and limited access to neuropathological confirmation [6 Histologically, GBM is classified as a grade IV astrocytoma under the 2021 WHO classification of central nervous system tumors [ 7 ]. It is characterized by rapid cellular proliferation, diffuse infiltration, angiogenesis, and necrosis [ 8 ]. Molecular markers such as IDH mutation and MGMT promoter methylation are now integral to diagnosis and prognosis [ 9 ]. Clinically, GBM presents most commonly with signs of increased intracranial pressure, motor deficits, and seizures [ 10 ]. Without treatment, survival rarely exceeds a few months. Even with optimal management—maximal safe resection followed by radiotherapy and concomitant and adjuvant temozolomide, known as the Stupp protocol—median survival remains limited to 12–15 months [ 11 ]. In our context at the Yaoundé General Hospital, GBM accounted for 5.1% of all intracranial tumors operated during the study period, a figure consistent with findings previously reported by Djientcheu et al . in the Central Hospital of Yaoundé [ 6 ]. Despite evidence supporting the benefit of multimodal management, access to radiotherapy, chemotherapy, and molecular testing remains highly constrained in many low-income countries, including Cameroon [ 12 ]. These limitations can compromise both survival outcomes and quality of life in affected patients. This study aimed to describe the diagnostic patterns, therapeutic strategies, survival outcomes, and quality of life of patients operated on for glioblastoma at the Yaoundé General Hospital. MATERIALS AND METHODS Study Design and Setting This study was designed as a descriptive cross-sectional study conducted in the Department of Neurosurgery at the Yaoundé General Hospital, a first-category referral hospital within the Cameroonian health system. The hospital is located in Yaoundé, in the Djoungolo Health District, Ngousso Health Area. The neurosurgery department is managed by an associate professor of neurosurgery and a consultant neurosurgeon, assisted by residents, interns, a general practitioner, a ward matron, nurses, and support staff. The department has a total capacity of 25 hospital beds distributed across seven wards. The study was conducted over a period of eight months, from November 2024 to June 2025. Study Population The target population for this study included all patients presenting with intracranial tumors requiring surgical intervention. The source population was defined as patients operated for glioblastoma at the Yaoundé General Hospital between January 2018 and June 2025, with histopathological confirmation of the diagnosis. Eligible participants were those who had undergone surgical resection for glioblastoma within the specified period and had available histopathological proof of glioblastoma. Patients whose medical records could not be retrieved or were incomplete were excluded from the study. Sample Size and Sampling Procedure The sampling procedure was consecutive and exhaustive. This meant that all eligible patients who met the inclusion criteria during the study period were systematically included. The approach ensured a representative cohort by minimizing selection bias and capturing all surgically managed cases of glioblastoma over the specified timeframe. Data Collection and Variables Data collection was carried out through structured questionnaires, review of medical records, and clinical interviews. A pre-established technical sheet was used to record patient information. The variables collected included sociodemographic data such as age, sex, occupation, educational level, and region of origin. Medical history focused on comorbid conditions such as diabetes, hypertension, and exposure to ionizing radiation. Clinical data captured the presence of syndromes such as intracranial hypertension, irritative manifestations, or neurological deficits. Paraclinical information included the type of imaging performed, tumor localization, number of lesions, and associated abnormalities. Surgical data included the date of operation and the extent of resection. Histopathological findings were categorized into IDH-wildtype glioblastoma, IDH-mutant glioblastoma, or inconclusive GBM. Molecular and immunohistochemical markers analyzed included MGMT, ATRX, EGFR, and IDH mutation status. Additional data were collected on adjuvant treatments such as radiotherapy and chemotherapy. Outcomes included quality of life as measured by standardized scales, complications, postoperative neurological deficits, and survival data including date of death. Data Collection Tools The principal tool for assessing quality of life was the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) [ 13 ]. This internationally validated instrument is specifically designed for cancer patients and measures multiple dimensions of health-related quality of life. It consists of 30 items grouped into five functional scales (physical, role, cognitive, emotional, and social functioning), three symptom scales (fatigue, pain, nausea/vomiting), a global health status/quality of life scale, and several single items assessing additional symptoms such as insomnia, appetite loss, constipation, diarrhea, and financial difficulties. Scores are linearly transformed to a 0–100 scale, where higher functional scores and global health status scores indicate better quality of life, while higher symptom scores indicate greater symptom burden. The French version of the questionnaire was used, as it has been validated and adapted for francophone populations, and it was pre-tested among a pilot sample to ensure contextual relevance and comprehension. In addition to the EORTC QLQ-C30, medical records provided data on demographics, comorbidities, clinical characteristics, surgical details, postoperative complications, and adjuvant treatments. Clinical interviews were conducted to assess residual symptoms and functional recovery when data were not available in the medical records. Secondary materials, including systematic reviews, journal articles, meta-analyses, and theses, were used as references to strengthen the research process. Logistical tools such as laptops, internet access, USB drives, mobile phones, and stationery supported the data collection process. Ethical Considerations The study protocol was submitted for review and approval by the Institutional Ethics and Research Committee of the Faculty of Medicine and Biomedical Sciences of the University of Yaoundé I. Following this, clearance was also obtained from the Ethics Committee of the Yaoundé General Hospital. All participants were fully informed about the objectives and procedures of the study, and informed consent was obtained in either written or verbal form before enrollment. To ensure confidentiality, data were anonymized, coded, and securely stored with restricted access granted only to the research team. Risks to participants were minimal but included potential fatigue during completion of questionnaires and emotional distress during interviews. These were mitigated by supportive interactions and the option to withdraw from the study at any point without consequence. Statistical Analysis Data were entered into Microsoft Excel and exported to SPSS version 20 and R software for statistical analysis. Prior to analysis, data quality was assessed by checking for completeness, accuracy, and consistency, and variables were coded appropriately as categorical or continuous. Descriptive statistics were used to summarize the data, with continuous variables expressed as means, medians, standard deviations, and interquartile ranges, while categorical variables were presented as frequencies and percentages. For inferential analysis, survival was assessed using the Kaplan-Meier method to estimate overall survival probabilities. The Cox proportional hazards regression model was applied to identify factors associated with survival outcomes. The quality of life data obtained from the EORTC QLQ-C30 were analyzed using multiple linear regression to determine predictors of quality of life scores, while logistic regression was used to assess determinants of dichotomized quality of life outcomes (good versus poor). Missing data were examined for patterns, and where appropriate, imputation methods were applied to ensure statistical validity. Data visualization included Kaplan-Meier survival curves, histograms, and bar charts. RESULTS Demographic data and clinical characteristics A total of 32 patients were included, representing 5.1% of the 622 intracranial tumor surgeries performed during the study period at the Yaoundé General Hospital. The median age was 47.50 years [17.75; 59.75], the mean age was 42.9 ± 13.8 years. The extremes were 1 to 73 years. The most affected age group was 41–60 years (46.9%) (Fig. 1 ). There was a female predominance, with 21 women (65.6%) and 11 men, yielding a sex ratio of 0.52. Neurologic deficit was the most frequent presenting symptom, observed in 22 patients (68.8%), followed by signs of intracranial hypertension (43.7%) and generalized seizures (37.5%). The average time from onset of symptoms to consultation was 2.4 months. Hemiparesis was present in 65.6% of patients, with aphasia in 15.6% and visual impairment in 25%. Neuroimaging and tumor characteristics MRI was performed in 19 patients (59.4%), and CT in the remaining 13 (40.6%). Lesions were hypointense on T1, hyperintense on T2, with ring enhancement after gadolinium in most cases. Tumor location was predominantly temporal (30.8%), followed by frontal (23.1%) and parietal lobes (15.4%). Right-sided involvement was noted in 59.4% of cases. One patient had bilateral lesions. Histopathology and molecular data Histological confirmation of glioblastoma was obtained in all cases. Immunohistochemical and molecular profiling was limited due to availability, but MGMT methylation and IDH1 mutation testing were performed in 4 patients (12.5%). Treatment modalities All patients underwent surgical resection. Among them, 18 patients (56.3%) had surgery alone, 6 (18.7%) had surgery followed by radiotherapy, and 8 (25%) received surgery plus adjuvant radiochemotherapy according to the Stupp protocol. The average time between surgery and adjuvant therapy initiation was 4.5 weeks. Survival outcomes The overall mean survival was 10.2 months (range: 1–26 months). Survival by treatment type was as follows: Surgery alone: 4.9 months; Surgery + radiotherapy: 12.5 months; Surgery + radiochemotherapy: 13.4 months Kaplan-Meier analysis showed significantly better survival in patients receiving multimodal treatment. Two patients were still alive at 24 months of follow-up (Fig. 2 ). Correlations between variables and mortality Several correlations were analyzed: Age over 40 showed a trend toward increased mortality, although not statistically significant in multivariate analysis. Presence of comorbidities was not significantly associated with increased risk of death (Table 1). Table I : Correlation between sociodemographic characteristics and mortality VARIABLES Death Total N(%) P value Crude OR (95% CI) No N(%) = 3 Yes N(%) = 16 Age (in years) 0–20 1 (5.3%) 3 (15.8%) 4 (21.1%) 0.344 21–40 1 (5.3%) 1 (5.3%) 2 (10.5%) 0.373 0.250(0.012–5.261) 41–80 1 (5.3%) 12 (63.2%) 13 (68.4%) 0.157 0.08(0.03–2.603) Sex Male 3 (15.8%) 11 (57.9%) 14 (73.7%) 0.99 Female 0 (0.0%) 5 (26.3%) 5 (26.3%) Tumor location did not significantly influence survival (Table 2). Table II: Correlation between tumor location and mortality VARIABLES Death Total N(%) P value Crude OR ( 95%CI) No N(%) = 3 Yes N(%) = 16 Occipital lobe 0 (0.0%) 1 (5.26%) 1 (5.26%) 1 0 (0) Temporal lobe 0 (0%) 4 (21.05%) 4 (21.05%) 0,999 0 (0) Parietal lobe 1 (5.26%) 3 (15.79%) 4 (21.05%) 1 1.691 (0) Frontal lobe 0 (0.0%) 4 (21.05%) 4 (21.05%) 0,999 0 (0) Thalamus 0 (0.0%) 2 (10.52%) 2 (10.52%) 1 0 (0) Brainstem 1 (5.26%) 1 (5.26%) 2 (10.52%) 1 1.691 (0) Ventricular zone 1 (5.26%) 0 (0.0%) 1 (5.26%) 1 0 (0) A better general condition at presentation (as assessed by Karnofsky performance status) was associated with lower mortality (Table 3 ; 4). Table III: Correlation between general health condition and mortality VARIABLES Score P value Crude OR (95% CI) Preoperative KPS − 0.222 0.694 0.801(0.264–2.426) Postoperative KPS − 0.993 0.112 0.370(0.109–1.260) KPS at 1 month post-surgery − 1.651 0.158 0,192(0.019–1.902) KPS at 6 months post-surgery − 18.923 0.998 0(0) Table IV: Multivariate analysis (Binary Logistic Regression ; n = 15) VARIABLES Score P value Adjusted OR (95% CI) Age group (in years) 0–20 years (reference) 21–40 years -198.49 0.995 0 (0) 41–80 years -37.387 0.999 0 (0) Postoperative KPS − 82.634 0.995 0 (0) KPS at 1 month post-op 16.184 0.996 0 (0) Patients receiving combined treatment had better quality of life scores and longer survival compared to those receiving surgery alone (Table 5; 6). Table V : Mean survival according to the different therapeutic modalities Therapeutic Modalities Mean Estimate (months) 95% Confidence Interval Lower bound Upper bound Surgery only 4.917 ± 2.162 0.679 9.155 Surgery and radiotherapy 12.5 ± 3.767 5.117 19.883 Surgery, radiotherapy, and chemotherapy 13.429 ± 2.762 8.016 18.841 Overall 10.206 ± 1.863 6.555 13.856 Table VI : Overall statistical comparison Test Chi-square df Sig. Breslow (Generalized Wilcoxon) 5.692 2 0.058 Quality of Life Scores Quality of life was evaluated using the Karnofsky Performance Status (KPS) and EORTC QLQ-C30 : The mean Karnofsky score among all patients was 68.75%, with higher scores observed in patients receiving multimodal treatment (Fig. 3 ). The average EORTC QLQ-C30 global health status score was 69.4% among survivors (Fig. 4 ). DISCUSSION Demographic and clinical characteristics In our study, the mean age of patients operated for glioblastoma was 42.9 years, with a median of 47.5 years. This age is significantly lower than the average age reported in developed countries, where glioblastoma predominantly affects patients over 60 years. However, our findings are consistent with those of Haman et al. in Cameroon, who also reported a younger population [ 12 ]. This may reflect demographic differences or delayed diagnosis in older populations with limited access to neurosurgical care. Females were more represented in our series (65.6%), contrasting with global epidemiology that typically shows a male predominance [ 6 , 12 ]. This discrepancy may be explained by local referral biases or sample size limitations. The most frequent clinical presentation was neuroglical deficit (68.8%), followed by signs of intracranial hypertension (56.3%). These results align with previous studies that identified neurological deficits as common presenting symptoms in glioblastoma [ 14 , 15 ]. Symptom duration before consultation was an average of 3.5 months, similar to findings from African studies [ 6 , 15 ]. This suggests delayed access to specialized care, often due to financial constraints or diagnostic limitations. Comorbidities were present in about one-third of patients, mainly hypertension and diabetes, but were not significantly associated with prognosis. Paraclinical and histopathological characteristics MRI was the most used imaging modality (59.4%), followed by CT scan (40.6%), consistent with modern diagnostic standards [ 16 ]. The most frequent tumor location was the temporal lobe (30.8%), corroborating studies by Gilard et al. and Sasmita et al. who highlighted a predilection for temporal and frontal regions [ 4 , 7 ]. This can be explained by the fact that these regions have a high density of astrocytes and oligodendrocytes, which provide a large pool of susceptible cells for malignant transformation. Histological analysis confirmed all cases as glioblastoma, with 15.6% of patients benefiting from molecular profiling. Among them, 40% had IDH-mutated tumors, in agreement with WHO 2021 classification, which defines glioblastoma IDH-wildtype as the standard entity [ 5 , 17 , 18 ]. The limited use of biomolecular markers reflects the challenges in resource-limited settings, as noted by Djientcheu et al. [ 6 ]. Therapeutic modalities Surgical treatment was performed in all cases. Surgery alone was the most frequent approach (56.3%), followed by surgery with radiotherapy (18.8%) and surgery with chemoradiotherapy (25%). The role of maximal safe resection is well established in literature, and has been associated with improved survival [ 19 ]. The benefit of multimodal therapy, particularly the Stupp protocol, has been widely demonstrated [ 8 , 19 ]. Our results confirm this: patients who received surgery followed by chemoradiotherapy had a longer mean survival (13.4 months) compared to those treated with surgery alone (4.9 months), similar to findings by Stupp et al. [ 19 ]. However, access to adjuvant therapies remains limited in our context, due to financial and infrastructural barriers. This underlines the need for policies to facilitate access to radiotherapy and temozolomide in Sub-Saharan Africa. Quality of life and survival outcomes The average Karnofsky score at follow-up was 68.75, and the EORTC QLQ-C30 global health score was 69.4, indicating moderate functional autonomy. These results are comparable to those of Chen et al., who reported improved quality of life in patients treated with complete multimodal protocols [ 20 ]. Survival analysis showed a mean overall survival of 10.2 months, which increased to 13.4 months in patients receiving the full treatment protocol. This is close to the global average of 14–16 months described in the literature [ 20 , 21 ], demonstrating that, despite resource limitations, favorable outcomes can be achieved with standardized care. Correlations and prognostic factors In our analysis, age over 40 years was associated with increased mortality, in line with prior studies highlighting age as a major prognostic factor [ 22 ]. No significant association was found between sex or comorbidities and mortality, consistent with previous data [ 23 ]. The type of treatment received was strongly correlated with survival and quality of life. Patients treated with surgery plus chemoradiotherapy had significantly better outcomes, a trend observed globally [ 23 ]. Karnofsky performance status was also predictive of survival, as confirmed by prior publications [ 24 ]. Tumor location was not significantly associated with prognosis in our study, a finding that remains debated in the literature [ 25 ]. Limitations Our study is limited by its retrospective design, small sample size, and incomplete access to biomolecular data. Despite these limitations, it provides valuable insights into glioblastoma management in low-resource settings. Conclusion Glioblastoma affects all ages in our setting. Most patients consulted late, with neurological deficits and signs of intracranial hypertension being the predominant clinical features. MRI was the most used imaging modality, although its accessibility remains limited for many patients.Surgical resection remains the cornerstone of treatment. However, access to adjuvant therapies such as radiotherapy and temozolomide was limited, influencing overall survival. Patients who received multimodal treatment, particularly surgery followed by chemoradiotherapy, had better survival outcomes and improved quality of life. Despite significant resource constraints, our study demonstrates that with timely diagnosis and standardized treatment, outcomes comparable to global benchmarks can be achieved. Strengthening diagnostic capabilities, improving access to radiochemotherapy, and adopting a multidisciplinary approach are essential for optimizing the prognosis of glioblastoma in Sub-Saharan Africa. Declarations Conflict of interest The authors declare no conflict of interest. Authors contributions All authors have read and approved the final version of the manuscript. References Grochans S, Cybulska AM, Simińska D, Korbecki J, Kojder K, Chlubek D et al (2022) Epidemiol Glioblastoma Multiforme–Literature Rev Cancers 14(10):2412 Nicholas G, Jeffrey S (2024) Radial Glial Identity Is Promoted by Notch1 Signaling in the Murine Forebrain. Neuron 26(2):395–404 Perry J, Chambers A, Spithoff K, Laperriere N (2007) Gliadel wafers in the treatment of malignant glioma: a systematic review. 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Wiley Online Libr 70(4):299–312 Schnell O et al (2022) Advances in fluorescence-guided surgery for glioblastoma. Neurooncology 24(1):84 Vora A et al (2024) PET/MRI imaging for aged glioblastoma patients. J Nucl Med 65(2):234–241 Jones K et al (2022) Efficacy of intraoperative radiotherapy (IORT) in glioblastoma. Clin Oncol (R Coll Radiol) 172:e453–e466 Tanaka T, Osawa S, Miyakita Y, Takagashi M, Ohno M, Yanagisawa S et al (2023) Awake craniotomy for eloquent glioblastoma. Neurol Japan 16(15):2632 Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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06:28:28","extension":"html","order_by":11,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":91571,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7941577/v1/2af3aaf89ba142a732b0f8b5.html"},{"id":94632185,"identity":"2c051641-1b29-4f81-a862-94f93ea4d8b1","added_by":"auto","created_at":"2025-10-29 06:28:28","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":33506,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of the population according to age\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7941577/v1/5295654b6373d7166edf7bb0.png"},{"id":94632187,"identity":"7051b014-bc77-45ac-9ef8-9668a6bf6cc5","added_by":"auto","created_at":"2025-10-29 06:28:28","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":127646,"visible":true,"origin":"","legend":"\u003cp\u003eKaplan Meier survival curve of patients operated on for glioblastomas\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7941577/v1/e55a01a49a0dc42f16ac06f1.png"},{"id":94640394,"identity":"2213b44f-ad54-4ca0-aa15-a23fd6cb7ee4","added_by":"auto","created_at":"2025-10-29 07:49:22","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":58872,"visible":true,"origin":"","legend":"\u003cp\u003eGeneral condition according to the Karnofsky score\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7941577/v1/f9fde941431bfbcfc2d43e57.png"},{"id":94641019,"identity":"88470e2e-844d-4d72-bdf1-8c5b4e82baba","added_by":"auto","created_at":"2025-10-29 07:50:28","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":100545,"visible":true,"origin":"","legend":"\u003cp\u003eQuality of life according to the EORTC QLQ-C30\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-7941577/v1/95c8eb7e4dd411e14e3668b3.png"},{"id":94641152,"identity":"092ed063-415f-412f-905b-9c04e3bad29e","added_by":"auto","created_at":"2025-10-29 07:51:32","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1454637,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7941577/v1/780fd87f-cb59-441a-b2d2-b1ec3d5b1da7.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eQuality of life and outcomes of patients operated on for glioblastoma at the Yaoundé General Hospital\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eGlioblastoma multiforme (GBM) is the most common and most aggressive primary malignant brain tumor in adults, accounting for approximately 15% of all primary intracranial neoplasms and nearly 50% of gliomas worldwide [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. According to recent estimates, the global incidence of GBM ranges from 3.2 to 4.7 per 100,000 population per year, with higher rates reported in Western countries [\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. In Sub-Saharan Africa, accurate epidemiological data are scarce due to underdiagnosis, delayed imaging, and limited access to neuropathological confirmation [6\u003c/p\u003e\u003cp\u003eHistologically, GBM is classified as a grade IV astrocytoma under the 2021 WHO classification of central nervous system tumors [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. It is characterized by rapid cellular proliferation, diffuse infiltration, angiogenesis, and necrosis [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Molecular markers such as IDH mutation and MGMT promoter methylation are now integral to diagnosis and prognosis [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Clinically, GBM presents most commonly with signs of increased intracranial pressure, motor deficits, and seizures [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Without treatment, survival rarely exceeds a few months. Even with optimal management\u0026mdash;maximal safe resection followed by radiotherapy and concomitant and adjuvant temozolomide, known as the Stupp protocol\u0026mdash;median survival remains limited to 12\u0026ndash;15 months [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. In our context at the Yaound\u0026eacute; General Hospital, GBM accounted for 5.1% of all intracranial tumors operated during the study period, a figure consistent with findings previously reported by Djientcheu et \u003cem\u003eal\u003c/em\u003e. in the Central Hospital of Yaound\u0026eacute; [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Despite evidence supporting the benefit of multimodal management, access to radiotherapy, chemotherapy, and molecular testing remains highly constrained in many low-income countries, including Cameroon [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. These limitations can compromise both survival outcomes and quality of life in affected patients.\u003c/p\u003e\u003cp\u003eThis study aimed to describe the diagnostic patterns, therapeutic strategies, survival outcomes, and quality of life of patients operated on for glioblastoma at the Yaound\u0026eacute; General Hospital.\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy Design and Setting\u003c/h2\u003e\u003cp\u003eThis study was designed as a descriptive cross-sectional study conducted in the Department of Neurosurgery at the Yaound\u0026eacute; General Hospital, a first-category referral hospital within the Cameroonian health system. The hospital is located in Yaound\u0026eacute;, in the Djoungolo Health District, Ngousso Health Area. The neurosurgery department is managed by an associate professor of neurosurgery and a consultant neurosurgeon, assisted by residents, interns, a general practitioner, a ward matron, nurses, and support staff. The department has a total capacity of 25 hospital beds distributed across seven wards. The study was conducted over a period of eight months, from November 2024 to June 2025.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eStudy Population\u003c/h3\u003e\n\u003cp\u003eThe target population for this study included all patients presenting with intracranial tumors requiring surgical intervention. The source population was defined as patients operated for glioblastoma at the Yaound\u0026eacute; General Hospital between January 2018 and June 2025, with histopathological confirmation of the diagnosis. Eligible participants were those who had undergone surgical resection for glioblastoma within the specified period and had available histopathological proof of glioblastoma. Patients whose medical records could not be retrieved or were incomplete were excluded from the study.\u003c/p\u003e\n\u003ch3\u003eSample Size and Sampling Procedure\u003c/h3\u003e\n\u003cp\u003eThe sampling procedure was consecutive and exhaustive. This meant that all eligible patients who met the inclusion criteria during the study period were systematically included. The approach ensured a representative cohort by minimizing selection bias and capturing all surgically managed cases of glioblastoma over the specified timeframe.\u003c/p\u003e\n\u003ch3\u003eData Collection and Variables\u003c/h3\u003e\n\u003cp\u003eData collection was carried out through structured questionnaires, review of medical records, and clinical interviews. A pre-established technical sheet was used to record patient information. The variables collected included sociodemographic data such as age, sex, occupation, educational level, and region of origin. Medical history focused on comorbid conditions such as diabetes, hypertension, and exposure to ionizing radiation. Clinical data captured the presence of syndromes such as intracranial hypertension, irritative manifestations, or neurological deficits. Paraclinical information included the type of imaging performed, tumor localization, number of lesions, and associated abnormalities. Surgical data included the date of operation and the extent of resection. Histopathological findings were categorized into IDH-wildtype glioblastoma, IDH-mutant glioblastoma, or inconclusive GBM. Molecular and immunohistochemical markers analyzed included MGMT, ATRX, EGFR, and IDH mutation status. Additional data were collected on adjuvant treatments such as radiotherapy and chemotherapy. Outcomes included quality of life as measured by standardized scales, complications, postoperative neurological deficits, and survival data including date of death.\u003c/p\u003e\n\u003ch3\u003eData Collection Tools\u003c/h3\u003e\n\u003cp\u003eThe principal tool for assessing quality of life was the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. This internationally validated instrument is specifically designed for cancer patients and measures multiple dimensions of health-related quality of life. It consists of 30 items grouped into five functional scales (physical, role, cognitive, emotional, and social functioning), three symptom scales (fatigue, pain, nausea/vomiting), a global health status/quality of life scale, and several single items assessing additional symptoms such as insomnia, appetite loss, constipation, diarrhea, and financial difficulties. Scores are linearly transformed to a 0\u0026ndash;100 scale, where higher functional scores and global health status scores indicate better quality of life, while higher symptom scores indicate greater symptom burden. The French version of the questionnaire was used, as it has been validated and adapted for francophone populations, and it was pre-tested among a pilot sample to ensure contextual relevance and comprehension.\u003c/p\u003e\u003cp\u003eIn addition to the EORTC QLQ-C30, medical records provided data on demographics, comorbidities, clinical characteristics, surgical details, postoperative complications, and adjuvant treatments. Clinical interviews were conducted to assess residual symptoms and functional recovery when data were not available in the medical records. Secondary materials, including systematic reviews, journal articles, meta-analyses, and theses, were used as references to strengthen the research process. Logistical tools such as laptops, internet access, USB drives, mobile phones, and stationery supported the data collection process.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eEthical Considerations\u003c/h2\u003e\u003cp\u003e The study protocol was submitted for review and approval by the Institutional Ethics and Research Committee of the Faculty of Medicine and Biomedical Sciences of the University of Yaound\u0026eacute; I. Following this, clearance was also obtained from the Ethics Committee of the Yaound\u0026eacute; General Hospital. All participants were fully informed about the objectives and procedures of the study, and informed consent was obtained in either written or verbal form before enrollment. To ensure confidentiality, data were anonymized, coded, and securely stored with restricted access granted only to the research team. Risks to participants were minimal but included potential fatigue during completion of questionnaires and emotional distress during interviews. These were mitigated by supportive interactions and the option to withdraw from the study at any point without consequence.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eData were entered into Microsoft Excel and exported to SPSS version 20 and R software for statistical analysis. Prior to analysis, data quality was assessed by checking for completeness, accuracy, and consistency, and variables were coded appropriately as categorical or continuous. Descriptive statistics were used to summarize the data, with continuous variables expressed as means, medians, standard deviations, and interquartile ranges, while categorical variables were presented as frequencies and percentages.\u003c/p\u003e\u003cp\u003eFor inferential analysis, survival was assessed using the Kaplan-Meier method to estimate overall survival probabilities. The Cox proportional hazards regression model was applied to identify factors associated with survival outcomes. The quality of life data obtained from the EORTC QLQ-C30 were analyzed using multiple linear regression to determine predictors of quality of life scores, while logistic regression was used to assess determinants of dichotomized quality of life outcomes (good versus poor). Missing data were examined for patterns, and where appropriate, imputation methods were applied to ensure statistical validity. Data visualization included Kaplan-Meier survival curves, histograms, and bar charts.\u003c/p\u003e\u003c/div\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eDemographic data and clinical characteristics\u003c/h2\u003e\u003cp\u003eA total of 32 patients were included, representing 5.1% of the 622 intracranial tumor surgeries performed during the study period at the Yaound\u0026eacute; General Hospital. The median age was 47.50 years [17.75; 59.75], the mean age was 42.9\u0026thinsp;\u0026plusmn;\u0026thinsp;13.8 years. The extremes were 1 to 73 years. The most affected age group was 41\u0026ndash;60 years (46.9%) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). There was a female predominance, with 21 women (65.6%) and 11 men, yielding a sex ratio of 0.52.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eNeurologic deficit was the most frequent presenting symptom, observed in 22 patients (68.8%), followed by signs of intracranial hypertension (43.7%) and generalized seizures (37.5%). The average time from onset of symptoms to consultation was 2.4 months. Hemiparesis was present in 65.6% of patients, with aphasia in 15.6% and visual impairment in 25%.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eNeuroimaging and tumor characteristics\u003c/h2\u003e\u003cp\u003eMRI was performed in 19 patients (59.4%), and CT in the remaining 13 (40.6%). Lesions were hypointense on T1, hyperintense on T2, with ring enhancement after gadolinium in most cases. Tumor location was predominantly temporal (30.8%), followed by frontal (23.1%) and parietal lobes (15.4%). Right-sided involvement was noted in 59.4% of cases. One patient had bilateral lesions.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eHistopathology and molecular data\u003c/h2\u003e\u003cp\u003eHistological confirmation of glioblastoma was obtained in all cases. Immunohistochemical and molecular profiling was limited due to availability, but MGMT methylation and IDH1 mutation testing were performed in 4 patients (12.5%).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eTreatment modalities\u003c/h2\u003e\u003cp\u003eAll patients underwent surgical resection. Among them, 18 patients (56.3%) had surgery alone, 6 (18.7%) had surgery followed by radiotherapy, and 8 (25%) received surgery plus adjuvant radiochemotherapy according to the Stupp protocol. The average time between surgery and adjuvant therapy initiation was 4.5 weeks.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eSurvival outcomes\u003c/h2\u003e\u003cp\u003eThe overall mean survival was 10.2 months (range: 1\u0026ndash;26 months). Survival by treatment type was as follows:\u003c/p\u003e\u003cp\u003eSurgery alone: 4.9 months; Surgery\u0026thinsp;+\u0026thinsp;radiotherapy: 12.5 months; Surgery\u0026thinsp;+\u0026thinsp;radiochemotherapy: 13.4 months\u003c/p\u003e\u003cp\u003eKaplan-Meier analysis showed significantly better survival in patients receiving multimodal treatment. Two patients were still alive at 24 months of follow-up (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eCorrelations between variables and mortality\u003c/h2\u003e\u003cp\u003eSeveral correlations were analyzed:\u003c/p\u003e\u003cp\u003eAge over 40 showed a trend toward increased mortality, although not statistically significant in multivariate analysis.\u003c/p\u003e\u003cp\u003ePresence of comorbidities was not significantly associated with increased risk of death (Table\u0026nbsp;1).\u003c/p\u003e\u003cp\u003e\u003cb\u003eTable I : Correlation between sociodemographic characteristics and mortality\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabb\" border=\"1\"\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eVARIABLES\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eDeath\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003cp\u003eN(%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eP value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eCrude OR (95% CI)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003cp\u003eN(%)\u0026thinsp;=\u0026thinsp;3\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003cp\u003eN(%)\u0026thinsp;=\u0026thinsp;16\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (in years)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e0\u0026ndash;20\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1 (5.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3 (15.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4 (21.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.344\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e21\u0026ndash;40\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1 (5.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1 (5.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2 (10.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.373\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.250(0.012\u0026ndash;5.261)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e41\u0026ndash;80\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1 (5.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e12 (63.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e13 (68.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.157\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.08(0.03\u0026ndash;2.603)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMale\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3 (15.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e11 (57.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e14 (73.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFemale\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0 (0.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5 (26.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5 (26.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTumor location did not significantly influence survival (Table\u0026nbsp;2).\u003c/p\u003e\u003cp\u003e\u003cb\u003eTable II: Correlation between tumor location and mortality\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabc\" border=\"1\"\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eVARIABLES\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eDeath\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003cp\u003eN(%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eP value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eCrude OR ( 95%CI)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003cp\u003eN(%) = 3\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003cp\u003eN(%)\u0026thinsp;=\u0026thinsp;16\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eOccipital lobe\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0 (0.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1 (5.26%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1 (5.26%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTemporal lobe\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0 (0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4 (21.05%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4 (21.05%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0,999\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eParietal lobe\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (5.26%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3 (15.79%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4 (21.05%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.691 (0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFrontal lobe\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0 (0.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4 (21.05%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4 (21.05%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0,999\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eThalamus\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0 (0.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2 (10.52%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2 (10.52%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBrainstem\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (5.26%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1 (5.26%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2 (10.52%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.691 (0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eVentricular zone\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (5.26%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0 (0.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1 (5.26%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eA better general condition at presentation (as assessed by Karnofsky performance status) was associated with lower mortality (Table\u0026nbsp;3 ; 4).\u003c/p\u003e\u003cp\u003e\u003cb\u003eTable III: Correlation between general health condition and mortality\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabd\" border=\"1\"\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVARIABLES\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eScore\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eP value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eCrude OR (95% CI)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePreoperative KPS\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;0.222\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.694\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.801(0.264\u0026ndash;2.426)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePostoperative KPS\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;0.993\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.112\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.370(0.109\u0026ndash;1.260)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eKPS at 1 month post-surgery\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;1.651\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.158\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0,192(0.019\u0026ndash;1.902)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eKPS at 6 months post-surgery\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;18.923\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.998\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0(0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eTable IV: Multivariate analysis (Binary Logistic Regression ; n\u0026thinsp;=\u0026thinsp;15)\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabe\" border=\"1\"\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVARIABLES\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eScore\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eP value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAdjusted OR (95% CI)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge group (in years)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003e0\u0026ndash;20 years \u003cem\u003e(reference)\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e21\u0026ndash;40 years\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-198.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.995\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003e41\u0026ndash;80 years\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-37.387\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.999\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePostoperative KPS\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;82.634\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.995\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eKPS at 1 month post-op\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e16.184\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.996\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003ePatients receiving combined treatment had better quality of life scores and longer survival compared to those receiving surgery alone (Table\u0026nbsp;5; 6).\u003c/p\u003e\u003cp\u003e\u003cb\u003eTable V : Mean survival according to the different therapeutic modalities\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabf\" border=\"1\"\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eTherapeutic Modalities\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eMean Estimate (months)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e95% Confidence Interval\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eLower bound\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eUpper bound\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSurgery only\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e4.917\u0026thinsp;\u0026plusmn;\u0026thinsp;2.162\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.679\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e9.155\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSurgery and radiotherapy\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e12.5\u0026thinsp;\u0026plusmn;\u0026thinsp;3.767\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5.117\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e19.883\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSurgery, radiotherapy, and chemotherapy\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e13.429\u0026thinsp;\u0026plusmn;\u0026thinsp;2.762\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8.016\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e18.841\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eOverall\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e10.206\u0026thinsp;\u0026plusmn;\u0026thinsp;1.863\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6.555\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e13.856\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eTable VI : Overall statistical comparison\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabg\" border=\"1\"\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTest\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eChi-square\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003edf\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSig.\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBreslow (Generalized Wilcoxon)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5.692\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.058\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003eQuality of Life Scores\u003c/h2\u003e\u003cp\u003eQuality of life was evaluated using the Karnofsky Performance Status (KPS) and EORTC QLQ-C30 :\u003c/p\u003e\u003cp\u003eThe mean Karnofsky score among all patients was 68.75%, with higher scores observed in patients receiving multimodal treatment (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThe average EORTC QLQ-C30 global health status score was 69.4% among survivors (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003eDemographic and clinical characteristics\u003c/h2\u003e\u003cp\u003eIn our study, the mean age of patients operated for glioblastoma was 42.9 years, with a median of 47.5 years. This age is significantly lower than the average age reported in developed countries, where glioblastoma predominantly affects patients over 60 years. However, our findings are consistent with those of Haman et al. in Cameroon, who also reported a younger population [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. This may reflect demographic differences or delayed diagnosis in older populations with limited access to neurosurgical care.\u003c/p\u003e\u003cp\u003eFemales were more represented in our series (65.6%), contrasting with global epidemiology that typically shows a male predominance [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. This discrepancy may be explained by local referral biases or sample size limitations. The most frequent clinical presentation was neuroglical deficit (68.8%), followed by signs of intracranial hypertension (56.3%). These results align with previous studies that identified neurological deficits as common presenting symptoms in glioblastoma [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Symptom duration before consultation was an average of 3.5 months, similar to findings from African studies [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. This suggests delayed access to specialized care, often due to financial constraints or diagnostic limitations. Comorbidities were present in about one-third of patients, mainly hypertension and diabetes, but were not significantly associated with prognosis.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\u003ch2\u003eParaclinical and histopathological characteristics\u003c/h2\u003e\u003cp\u003eMRI was the most used imaging modality (59.4%), followed by CT scan (40.6%), consistent with modern diagnostic standards [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. The most frequent tumor location was the temporal lobe (30.8%), corroborating studies by Gilard et al. and Sasmita et al. who highlighted a predilection for temporal and frontal regions [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. This can be explained by the fact that these regions have a high density of astrocytes and oligodendrocytes, which provide a large pool of susceptible cells for malignant transformation.\u003c/p\u003e\u003cp\u003eHistological analysis confirmed all cases as glioblastoma, with 15.6% of patients benefiting from molecular profiling. Among them, 40% had IDH-mutated tumors, in agreement with WHO 2021 classification, which defines glioblastoma IDH-wildtype as the standard entity [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. The limited use of biomolecular markers reflects the challenges in resource-limited settings, as noted by Djientcheu et al. [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\u003ch2\u003eTherapeutic modalities\u003c/h2\u003e\u003cp\u003eSurgical treatment was performed in all cases. Surgery alone was the most frequent approach (56.3%), followed by surgery with radiotherapy (18.8%) and surgery with chemoradiotherapy (25%). The role of maximal safe resection is well established in literature, and has been associated with improved survival [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe benefit of multimodal therapy, particularly the Stupp protocol, has been widely demonstrated [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Our results confirm this: patients who received surgery followed by chemoradiotherapy had a longer mean survival (13.4 months) compared to those treated with surgery alone (4.9 months), similar to findings by Stupp et al. [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eHowever, access to adjuvant therapies remains limited in our context, due to financial and infrastructural barriers. This underlines the need for policies to facilitate access to radiotherapy and temozolomide in Sub-Saharan Africa.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec22\" class=\"Section2\"\u003e\u003ch2\u003eQuality of life and survival outcomes\u003c/h2\u003e\u003cp\u003eThe average Karnofsky score at follow-up was 68.75, and the EORTC QLQ-C30 global health score was 69.4, indicating moderate functional autonomy. These results are comparable to those of Chen et al., who reported improved quality of life in patients treated with complete multimodal protocols [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eSurvival analysis showed a mean overall survival of 10.2 months, which increased to 13.4 months in patients receiving the full treatment protocol. This is close to the global average of 14\u0026ndash;16 months described in the literature [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], demonstrating that, despite resource limitations, favorable outcomes can be achieved with standardized care.\u003c/p\u003e\u003cdiv id=\"Sec23\" class=\"Section3\"\u003e\u003ch2\u003eCorrelations and prognostic factors\u003c/h2\u003e\u003cp\u003eIn our analysis, age over 40 years was associated with increased mortality, in line with prior studies highlighting age as a major prognostic factor [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. No significant association was found between sex or comorbidities and mortality, consistent with previous data [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe type of treatment received was strongly correlated with survival and quality of life. Patients treated with surgery plus chemoradiotherapy had significantly better outcomes, a trend observed globally [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Karnofsky performance status was also predictive of survival, as confirmed by prior publications [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eTumor location was not significantly associated with prognosis in our study, a finding that remains debated in the literature [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec24\" class=\"Section2\"\u003e\u003ch2\u003eLimitations\u003c/h2\u003e\u003cp\u003eOur study is limited by its retrospective design, small sample size, and incomplete access to biomolecular data. Despite these limitations, it provides valuable insights into glioblastoma management in low-resource settings.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eGlioblastoma affects all ages in our setting. Most patients consulted late, with neurological deficits and signs of intracranial hypertension being the predominant clinical features. MRI was the most used imaging modality, although its accessibility remains limited for many patients.Surgical resection remains the cornerstone of treatment. However, access to adjuvant therapies such as radiotherapy and temozolomide was limited, influencing overall survival. Patients who received multimodal treatment, particularly surgery followed by chemoradiotherapy, had better survival outcomes and improved quality of life.\u003c/p\u003e\u003cp\u003eDespite significant resource constraints, our study demonstrates that with timely diagnosis and standardized treatment, outcomes comparable to global benchmarks can be achieved. Strengthening diagnostic capabilities, improving access to radiochemotherapy, and adopting a multidisciplinary approach are essential for optimizing the prognosis of glioblastoma in Sub-Saharan Africa.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003ch2\u003eConflict of interest\u003c/h2\u003e\u003cp\u003eThe authors declare no conflict of interest.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eAuthors contributions\u003c/h2\u003e\u003cp\u003eAll authors have read and approved the final version of the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eGrochans S, Cybulska AM, Simińska D, Korbecki J, Kojder K, Chlubek D et al (2022) Epidemiol Glioblastoma Multiforme\u0026ndash;Literature Rev Cancers 14(10):2412\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNicholas G, Jeffrey S (2024) Radial Glial Identity Is Promoted by Notch1 Signaling in the Murine Forebrain. Neuron 26(2):395\u0026ndash;404\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePerry J, Chambers A, Spithoff K, Laperriere N (2007) Gliadel wafers in the treatment of malignant glioma: a systematic review. Curr Oncol 14(5):189\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSasmita AO, Wong YP, Ling APK (2018) Biomarkers and therapeutic advances in glioblastoma multiforme. Asia Pac J Clin Oncol 14(1):40\u0026ndash;51\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChen J, Han P, Dahiya S (2022) Glioblastoma: Changing concepts in the WHO CNS5 classification. Indian J Pathol Microbiol 65(Suppl 1):S24\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDjientcheu VP, Haman O, Bito OB, Ndome O, Guegang GE (2019) Les tumeurs c\u0026eacute;r\u0026eacute;brales: Quel algorithme pour une prise en charge utile et efficiente \u0026agrave; l\u0026rsquo;H\u0026ocirc;pital Central de Yaound\u0026eacute; ? Med Afr. Noire 13:16\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGilard V, Tebani A, Dabaj I, Laquerri\u0026egrave;re A, Fontanilles M, Derrey S et al (2021) Diagnosis and Management of Glioblastoma: A Comprehensive Perspective. J Pers Med 11(4):258\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eStupp R, Mason WP, Bent MJ, van den, Weller M, Fisher B, Taphoorn MJB et al (2005) Radiotherapy plus Concomitant and Adjuvant Temozolomide for Glioblastoma. N Engl J Med 352(10):987\u0026ndash;996\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eQuinn T, Gino C, Report CBTRUSS (2018) Primary Brain and Other Central Nervous System Tumors Diagnosed in the United States in 2014\u0026ndash;2018 | Neuro-Oncology | Oxford Academic\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eXu J Rho GTPases in Glioblastoma Mechanobiology.2020\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMichael W, van den Martin B (2021) EANO guidelines on the diagnosis and treatment of diffuse gliomas of adulthood |. Nat Reviews Clin Oncol 18(3):170\u0026ndash;186\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHaman NO, Ndome TO, Fogue D, Djientcheu C, Nzedzou G, Baboke I, Djientcheu VP (2025) Qualit\u0026eacute; de vie et survie actuarielle des patients op\u0026eacute;r\u0026eacute;s de glioblastomes \u0026agrave; Yaound\u0026eacute;. J Neurol Neurochir Psychiatr Afr 7(27):171\u0026ndash;180\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMichael V, Harry V (2010) Astrocytes: biology and pathology |. Acta Neuropathol 119:7\u0026ndash;35\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBailey P, Cushing H (1926) A classification of the tumors of the glioma group on a histogenetic basis with a correlated study of prognosis. Lippincott\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWalker D (1980) Randomized Comparisons of Radiotherapy and Nitrosoureas for the Treatment of Malignant Glioma after Surgery |. N Engl J Med 303(23):1323\u0026ndash;1329\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePatrick Nk Ciblage du glioblastome multiforme par les inhibiteurs de BMI1.Universit\u0026eacute; de Montreal.2019\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFrank B, Furnari AM, Fenton (2007) Malignant astrocytic glioma: genetics, biology, and paths to treatment. Genes Dev 21(21):2683\u0026ndash;2710\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFigarella-Branger D, Bouvier C, Moroch J, Michalak S (2010) Burel-Vandenbos. Classification morphologique des glioblastomes. Neurochirurgie 56(6):459\u0026ndash;463\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eStupp R, Wong ET, Kanner AA, Steinberg D, Engelhard H, Heidecke V et al (2012) NovoTTF-100A versus physician\u0026rsquo;s choice chemotherapy in recurrent glioblastoma: A randomised phase III trial of a novel treatment modality. Eur J Cancer 48(14):2192\u0026ndash;2202\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMichon Mo MK, Rosenblum MH (1996) Bilsky. Survivants \u0026agrave; long terme du glioblastome multiforme: caract\u0026eacute;ristiques cliniques et mol\u0026eacute;culaires |. J Neurooncol 27(3):259\u0026ndash;266\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAraon C, David M (2020) Management of glioblastoma: State of the art and future directions - Tan \u0026ndash;\u0026thinsp;2020 - CA: A Cancer Journal for Clinicians -. Wiley Online Libr 70(4):299\u0026ndash;312\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSchnell O et al (2022) Advances in fluorescence-guided surgery for glioblastoma. Neurooncology 24(1):84\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVora A et al (2024) PET/MRI imaging for aged glioblastoma patients. J Nucl Med 65(2):234\u0026ndash;241\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJones K et al (2022) Efficacy of intraoperative radiotherapy (IORT) in glioblastoma. Clin Oncol (R Coll Radiol) 172:e453\u0026ndash;e466\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTanaka T, Osawa S, Miyakita Y, Takagashi M, Ohno M, Yanagisawa S et al (2023) Awake craniotomy for eloquent glioblastoma. Neurol Japan 16(15):2632\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"(1)\tDepartment of Surgery and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaounde 1 (Yaoundé, Cameroon)","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"glioblastoma, quality of life, survival, Yaoundé General Hospital","lastPublishedDoi":"10.21203/rs.3.rs-7941577/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7941577/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003e Glioblastoma is the most common and aggressive primary malignant brain tumor in adults, with a poor prognosis despite multimodal treatment. This study aimed to describe the diagnostic aspects, therapeutic strategies, quality of life and outcomes of patients operated on for glioblastoma at the Yaoundé General Hospital.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e This was a descriptive cross-sectional study conducted at the Yaoundé General Hospital. Included were 32 patients who underwent surgery for glioblastoma with histological evidence from January 2019 to June 2025. Data were collected from medical records and analyzed using SPSS version 25. Quality of life was assessed using the Karnofsky and EORTC QLQ-C30 scores. Factors associated with the quality of life and outcomes where identified and a P value \u0026lt; 0.05 was considered significant.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Thirty-two patients were included, with a median age of 47.50 years [17.75 ;59.75], mean age of 42.9 ± 13.8 years and a female predominance (65.6%). The most common presenting symptom was neurologic deficit (68.8%). MRI was the main diagnostic modality (59.4%), and the tumor was most often located in the temporal lobe (30.8%). Surgery alone was performed in 56.3% of cases, while 25% received surgery followed by radiochemotherapy. The average overall survival was 10.2 months, increasing to 13.4 months in patients who received the full multimodal treatment. Quality of life scores were also better in this group. Age greater than 60 was found to be significantly associated with poor outcome.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e Glioblastoma affects all ages in our setting. Combined therapeutic strategies, especially the addition of radiochemotherapy after surgery, were associated with longer survival and better quality of life. Multidisciplinary management remains essential to improve outcomes.\u003c/p\u003e","manuscriptTitle":"Quality of life and outcomes of patients operated on for glioblastoma at the Yaoundé General Hospital","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-29 06:28:23","doi":"10.21203/rs.3.rs-7941577/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"39104176-eeb5-4bd1-9faf-2a718eea0349","owner":[],"postedDate":"October 29th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":56839570,"name":"Neurology"},{"id":56839571,"name":"Oncology"},{"id":56839572,"name":"Neurosurgery"}],"tags":[],"updatedAt":"2025-10-29T06:28:24+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-29 06:28:23","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7941577","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7941577","identity":"rs-7941577","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}