High-grade gliomas where resources define survival: a systematic review and meta-analysis of outcomes, surgical access, and molecular diagnostic gaps in low- and middle-income countries
13 affiliations
- 1Department of Neurosurgery, Servicio of the 1ro de Octubre Hospital of the Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado , , ,
- 2Neurosurgical Oncology, Mexico’s National Institute of Cancer , ,
- 3Department of Neurosurgery, Centro Medico ISSEMYM Toluca , ,
- 4Department of Neurosurgery, National University of Mexico Hospital General , ,
- 5Department of Neurosurgery, Hospital Militar de Quito , ,
- 6Department of Neurology, Neurosurgery & Neurogenetics, ChromoMED Institute , ,
- 7Department of Neurosurgery, Hospital Regional Alejandro Cabral , ,
- 8Department of Neurosurgery, Russian People’s Friendship University , ,
- 9Intensive Care Unit, Hospital Traumatológico Dr. Ney Arias Lora , ,
- 10Faculty of Medicine, Autonomous University of Santo Domingo , ,
- 11ChromoMED Institute , ,
- 12Istinye Universitesi , ,
- 13Department of Neurosurgery, Hospital traumatologico de Azua , ,
Abstract
Background: High-grade gliomas remain among the most aggressive tumors in neuro-oncology. Although prognosis is strongly influenced by tumor biology, survival in low- and middle-income countries is also shaped by health-system factors, including delayed diagnosis, limited surgical infrastructure, incomplete adjuvant therapy, and restricted molecular diagnostics. The implementation of the 2021 World Health Organization Classification of Central Nervous System Tumors has further exposed diagnostic inequities, as integrated histomolecular classification depends on molecular tools that are not uniformly available in resource-limited settings.
Objective: This systematic review and meta-analysis aimed to synthesize contemporary evidence on survival outcomes, surgical access, extent of resection, adjuvant treatment delivery, and molecular diagnostic gaps among patients with high-grade gliomas treated in low- and middle-income countries.
Methods: A systematic search was conducted following PRISMA 2020 recommendations. MEDLINE/PubMed, Embase, Scopus, Web of Science, Cochrane CENTRAL, Global Index Medicus, LILACS, African Index Medicus, IndMED, and Google Scholar were searched for studies published between January 2016 and May 2026. Eligible studies included patients with histologically or molecularly confirmed WHO grade 3 or grade 4 gliomas treated in low- or middle-income countries and reporting survival, surgical-access, adjuvant-treatment, or molecular-diagnostic outcomes. The protocol was registered in PROSPERO as CRD420261398058.
Results: A total of 30 independent studies met the predefined eligibility criteria and were included in the qualitative synthesis. Twenty-four studies contributed overall survival data, 18 reported surgical-access outcomes, 21 evaluated adjuvant-treatment delivery, and 12 examined molecular-diagnostic availability. Most included investigations were retrospective institutional cohorts, although registry-based studies, randomized clinical trials, and molecular implementation studies were also identified. Survival outcomes varied substantially across healthcare settings and were consistently influenced by delayed diagnosis, limited access to maximal safe resection, incomplete radiotherapy, restricted temozolomide availability, treatment abandonment, and insufficient molecular characterization.
Conclusions: Survival in high-grade gliomas in low- and middle-income countries is not determined by tumor biology alone. It is shaped by sequential “survival gates”: timely diagnosis, access to maximal safe resection, completion of radiotherapy and temozolomide-based chemotherapy, molecular classification, and longitudinal follow-up. Future strategies should move beyond simple guideline translation and focus on scalable neuro-oncology pathways that improve surgical capacity, adjuvant-treatment continuity, and access to essential molecular diagnostics.
Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261398058 , identifier CRD420261398058.
Related
- Thermal variability and the geography of optimal temperature for child survival: childhood respiratory-infection mortality in 171 countries: a systematic analysis of the Global Burden of Disease Study 2023 and the C-LSAT high-resolution climate dataset
- Molecular and Conventional Tests in Onychomycosis: A Systematic Review of Paired Diagnostic Discordance and Clinical Interpretation
- Molecular Profiles, Treatment-Associated Survival, and Prognosis in Early-Onset Versus Late-Onset Gastric Cancer: A Systematic Review and Meta-Analysis
- Diagnostic testing for pulmonary tuberculosis in low and middle-income countries: innovations to achieve universal access—a narrative review
- Incidence, prevalence, mortality and survival trends in women with endometrial-, ovarian- and cervical cancer in the Nordic countries (1980–2023) with focus on younger women (0–49 years old)
BibTeX
@article{rangel2026highgrade,
title = {{High-grade gliomas where resources define survival: a systematic review and meta-analysis of outcomes, surgical access, and molecular diagnostic gaps in low- and middle-income countries}},
author = {Carlos Castillo Rangel and Gervith Reyes Soto and Edinson David Berrio Perea and José De Jesús Gutiérrez-Baños and Eduardo Diaz Juarez and Bayron Salazar and Vishal K. Chavda and Ismael Antonio Peralta Baez and Renat Nurmukhametov and David Cuevas and Lizardi de la Cruz and Andreina Rosario Rosario and Bary Bigay and Abuzer Gungor and Manuel De Jesus Encarnacion Ramirez},
journal = {Frontiers in oncology},
year = {2026},
month = sep,
doi = {10.3389/fonc.2026.1909193},
url = {https://europepmc.org/article/PMC/PMC13662424},
note = {CC BY},
}
RIS
TY - JOUR
TI - High-grade gliomas where resources define survival: a systematic review and meta-analysis of outcomes, surgical access, and molecular diagnostic gaps in low- and middle-income countries
AU - Carlos Castillo Rangel
AU - Gervith Reyes Soto
AU - Edinson David Berrio Perea
AU - José De Jesús Gutiérrez-Baños
AU - Eduardo Diaz Juarez
AU - Bayron Salazar
AU - Vishal K. Chavda
AU - Ismael Antonio Peralta Baez
AU - Renat Nurmukhametov
AU - David Cuevas
AU - Lizardi de la Cruz
AU - Andreina Rosario Rosario
AU - Bary Bigay
AU - Abuzer Gungor
AU - Manuel De Jesus Encarnacion Ramirez
PY - 2026
DA - 2026/09/30
JO - Frontiers in oncology
DO - 10.3389/fonc.2026.1909193
UR - https://europepmc.org/article/PMC/PMC13662424
AB - Background: High-grade gliomas remain among the most aggressive tumors in neuro-oncology. Although prognosis is strongly influenced by tumor biology, survival in low- and middle-income countries is also shaped by health-system factors, including delayed diagnosis, limited surgical infrastructure, incomplete adjuvant therapy, and restricted molecular diagnostics. The implementation of the 2021 World Health Organization Classification of Central Nervous System Tumors has further exposed diagnostic inequities, as integrated histomolecular classification depends on molecular tools that are not uniformly available in resource-limited settings. Objective: This systematic review and meta-analysis aimed to synthesize contemporary evidence on survival outcomes, surgical access, extent of resection, adjuvant treatment delivery, and molecular diagnostic gaps among patients with high-grade gliomas treated in low- and middle-income countries. Methods: A systematic search was conducted following PRISMA 2020 recommendations. MEDLINE/PubMed, Embase, Scopus, Web of Science, Cochrane CENTRAL, Global Index Medicus, LILACS, African Index Medicus, IndMED, and Google Scholar were searched for studies published between January 2016 and May 2026. Eligible studies included patients with histologically or molecularly confirmed WHO grade 3 or grade 4 gliomas treated in low- or middle-income countries and reporting survival, surgical-access, adjuvant-treatment, or molecular-diagnostic outcomes. The protocol was registered in PROSPERO as CRD420261398058. Results: A total of 30 independent studies met the predefined eligibility criteria and were included in the qualitative synthesis. Twenty-four studies contributed overall survival data, 18 reported surgical-access outcomes, 21 evaluated adjuvant-treatment delivery, and 12 examined molecular-diagnostic availability. Most included investigations were retrospective institutional cohorts, although registry-based studies, randomized clinical trials, and molecular implementation studies were also identified. Survival outcomes varied substantially across healthcare settings and were consistently influenced by delayed diagnosis, limited access to maximal safe resection, incomplete radiotherapy, restricted temozolomide availability, treatment abandonment, and insufficient molecular characterization. Conclusions: Survival in high-grade gliomas in low- and middle-income countries is not determined by tumor biology alone. It is shaped by sequential “survival gates”: timely diagnosis, access to maximal safe resection, completion of radiotherapy and temozolomide-based chemotherapy, molecular classification, and longitudinal follow-up. Future strategies should move beyond simple guideline translation and focus on scalable neuro-oncology pathways that improve surgical capacity, adjuvant-treatment continuity, and access to essential molecular diagnostics. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261398058 , identifier CRD420261398058.
SN - 2234-943X
ER -