Surgical and survival outcomes of hemispheric low-grade glioma in Ethiopia: a multicenter retrospective cohort study

Background Outcome data for hemispheric low-grade glioma from resource-limited settings remain limited. This study describes surgical, seizure, and survival outcomes among patients treated at two tertiary centers in Ethiopia. Objective To describe surgical, seizure, and survival outcomes and explore factors associated with overall survival among patients undergoing surgery for hemispheric low-grade glioma. Methods We conducted a multicenter retrospective cohort study of patients who underwent surgery for hemispheric low-grade glioma at two tertiary hospitals in Addis Ababa, Ethiopia, between January 2015 and December 2020. Demographic, clinical, radiologic, operative, histopathologic, treatment, and follow-up data were analyzed. Overall survival was estimated using the Kaplan-Meier method. Associations with survival were explored using univariable Cox proportional hazards analyses. Given the small number of events, survival-factor analyses were considered exploratory. Results Thirty-four patients constituted the clinical cohort, with a median age of 39 years. Gross-total resection was performed in 23 (67.6%) patients. Thirty-one patients had sufficient information for time-to-event analysis, among whom 13 deaths were observed. Kaplan-Meier estimated overall survival was 96.7% at 1 year, 67.2% at 2 years, and 53.5% at 3 years. No patients remained under observation at 60 months; therefore, a 5-year survival estimate was not reported. In exploratory univariable analyses, age>40 years, contrast enhancement, and subtotal resection were associated with higher mortality, whereas recorded postoperative chemoradiation was associated with lower mortality. Estimates were imprecise, with wide confidence intervals. Among 23 patients with documented postoperative seizure outcomes, 16 (69.6%) achieved Engel class I status. Conclusion This multicenter cohort provides real-world surgical and survival data for hemispheric low-grade glioma care in Ethiopia. Several clinical and treatment characteristics were associated with survival, but the small number of events, incomplete follow-up, missing data, and absence of molecular classification preclude definitive conclusions regarding independent prognostic effects. Larger prospective studies incorporating contemporary molecular diagnostics and standardized longitudinal follow-up are needed.