Department of Medicine, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines.
College of Medicine, University of the Philippines Manila, Manila, Philippines.
Neurosurg Rev. 2022 Oct;45(5):3393-3403. doi: 10.1007/s10143-022-01844-x. Epub 2022 Aug 31.
Little is known about the survivorship of glioblastoma (GBM) patients in low- and middle-income countries (LMICs). We hypothesize that this would be lower than published figures for high-income countries due to cancer health disparities. We performed a systematic review and meta-analysis to estimate the median overall survival (OS) of GBM in LMICs and determine factors affecting OS. A systematic review of 12 electronic databases was conducted according to PRISMA guidelines to identify studies of newly diagnosed adult GBM patients done in countries classified as LMIC by the World Bank (WB) from inception to December 2020. Random effects meta-analysis of collected median overall survival data was done. Subgroup analysis and meta-regression were done to determine if WB income classification (WBIC), start year of recruitment (pre- or post-popularization of the standard Stupp protocol), and treatment modality affected OS. The 24 articles (n = 2,552) that met the inclusion criteria were from 8 low-middle income and upper-middle income countries, with 0 articles from low-income countries. Random effects analysis of 24 studies showed a pooled median OS of 14.17 months (95% CI 12.90-15.43, I = 79). Subgroup analysis showed a significant difference (p < 0.05) in the pooled median OS of studies predating Stupp protocol (12.54 mo, 95% CI 11.13-13.96, I = 80%; n = 1027) and studies postdating Stupp protocol (15.64 mo, 95% CI 13.58-17.69, I = 77; n = 1412). Subgroup analysis of WBIC and treatment modalities did not show significant differences. Published data on the survivorship of GBM patients in LMICs is sparse, highlighting the need for good quality pragmatic studies from LMICs. The limited evidence suggests improving survivorship after introduction of the Stupp protocol.
关于中低收入国家（LMICs）胶质母细胞瘤（GBM）患者的生存情况知之甚少。我们假设，由于癌症健康方面的差异，这一数字将低于高收入国家公布的数据。我们进行了一项系统评价和荟萃分析，以估计 LMIC 中 GBM 的中位总生存期（OS），并确定影响 OS 的因素。根据 PRISMA 指南，对 12 个电子数据库进行了系统评价，以确定自成立以来至 2020 年 12 月在世界银行（WB）分类为 LMIC 的国家中对新诊断的成年 GBM 患者进行的研究。对收集的中位总生存数据进行了随机效应荟萃分析。进行了亚组分析和荟萃回归分析，以确定 WB 收入分类（WBIC）、招募开始年份（在 Stupp 标准方案普及之前或之后）以及治疗方式是否影响 OS。符合纳入标准的 24 篇文章（n = 2552）来自 8 个中低收入和中上收入国家，没有来自低收入国家的文章。对 24 项研究的随机效应分析显示，汇总的中位 OS 为 14.17 个月（95%CI 12.90-15.43，I = 79）。亚组分析显示，在 Stupp 方案之前（12.54 mo，95%CI 11.13-13.96，I = 80%；n = 1027）和 Stupp 方案之后（15.64 mo，95%CI 13.58-17.69，I = 77；n = 1412）进行的研究中，汇总的中位 OS 存在显著差异（p < 0.05）。WBIC 和治疗方式的亚组分析未显示出显著差异。关于 LMIC 中 GBM 患者生存情况的发表数据很少，这突出表明需要来自 LMIC 的高质量实用研究。有限的证据表明，在引入 Stupp 方案后，生存率有所提高。
