Clinico-pathologic features and early surgical outcome of astrocytomas in Eldoret, Kenya

Abstract

Background: Astrocytomas are a group of primary central nervous system tumors arising from astrocytes and accounting for up to 37.8% of all brain tumors seen in hospital-based studies from Africa. Despite being one of the commonest types of brain tumors, their patterns and short-term outcomes remain poorly studied in Kenya and the greater East African region. Objective: To describe the clinico-pathologic features as well as surgical and functional outcome of astrocytomas in Eldoret, Kenya. Methods: Prospective, descriptive census study involving consecutive patients with a histological diagnosis of astrocytoma seen in three hospitals located in Eldoret, Kenya. Clinical, MRI, pathological and treatment characteristics were recorded and patients followed up for 12 weeks after discharge from hospital. The study endpoints were early post-treatment complications and functional status. Results: Thirty-one patients constituting 25% of all patients with brain tumors were recruited over a one-year period. Females constituted 51.6% (N=16) of the sample. Headache (83.9%) and focal neurological deficits (64.5%) were the commonest presenting features. Compared to high grade tumors, low grade astrocytomas had a higher median duration of illness (90 Vs. 45 days; p-value=0.433), lower median functional status (KPS score 40 Vs. 50; p-value=0.663), lower median tumor size (18.86 Vs. 104.34 Cm3; p-value=0.022) and lower median MRI scores (9 Vs. 17; p-value=0.0001). Glioblastoma multiforme (71%) was the predominant histological subtype followed by diffuse astrocytoma (22.6%). The median Ki-67 proliferative index was 6% for pilocytic astrocytoma, 1.6% for diffuse astrocytoma and 60% for glioblastoma multiforme. All patients underwent surgery. Systemic surgical complications occurred in 6.5% of patients while regional complications occurred in 38.7%. Hematoma formation was the commonest regional surgical complication. The median length of hospital stay was 20 days for low grade tumors and 12 days for high grade tumors (p=0.828). In-hospital mortality was 19.4% and increased to 25.8% at 12 weeks. The KPS score at discharge was 50 and improved to 60 at 12 weeks. Only 9.7% (N=3) of patients had acceptable functional status at 12 weeks follow up. Conclusions: In this study, headache, focal neurological deficits and reduced functional status are the commonest presenting features of astrocytomas while Glioblastoma multiforme is the commonest histological subtype. MRI can be used to differentiate low grade astrocytomas from high grade astrocytomas.Further, the encountered astrocytomas are highly proliferative and in the short-term, both their surgical and functional outcome are suboptimal. Recommendations: Clinicians in peripheral facilities should be sensitized on early referral for patients with persistent neurological symptoms. Owing to increased proliferative activity, patients with astrocytoma in Eldoret should be followed up closely to detect recurrence early. More research is needed in order to determine the underlying mechanisms for the high proliferative activity of astrocytomas in this region as well as determine the reasons for the observed surgical and functional outcomes.