Glioblastoma (GBM) is the most frequent and most aggressive form of primary brain tumor in adults [1] [2] . Its epidemiology varies across regions of the world, with a higher incidence among Caucasians [3] . Despite significant advances in neuro-oncology, GBM continues to carry a dismal prognosis [2] [4] . The current standard of care is based on maximal safe surgical resection followed by concomitant radiotherapy and temozolomide chemotherapy, with adjuvant temozolomide cycles thereafter [5] - [8] .

Several prognostic factors have been identified in GBM, including age, neurological and cognitive status, tumor location, extent of resection, access to adjuvant therapies, and O6-Methylguanine-DNA Methyltransferase (MGMT) promoter methylation status [9] - [11] . Reported mean survival varies from 12 to 24 months depending on the combination of these factors [12] [13] .

Few studies from Africa have analyzed the outcomes of patients operated on for GBM [14] [15] . In our country, no prior study has specifically assessed postoperative survival following glioblastoma surgery. Given the aggressiveness of GBM and the limited resources available, postoperative outcome remains a major concern for patients and their families. The objective of this study was therefore to analyze the variables influencing survival in patients who underwent surgical treatment for glioblastoma in a low-resource environment.

The mean age was 53.3 years (range, 35 - 76). The male-to-female ratio was 2.1. The average time to surgery was 3 months (range, 2 weeks - 4 months). Presenting symptoms included intracranial hypertension (100%), motor deficit (65%), and seizures (38%). Sixty-five percent of patients had a KPS greater than 70%, and 35% had a KPS below 70%.

Tumors were most frequently frontal (42%), followed by temporal (30%) and parietal (25%) ( Figure 1 ). Multifocal lesions occurred in 3% of cases. Resection was total in 45%, subtotal in 32%, and partial in 16%; 7% of patients had biopsy only.

The Stupp protocol was administered in 26 patients (84%), with 6 incomplete courses. Five patients were lost to follow-up. Median overall survival was 9.86 months ( Figure 2(A) ). No significant survival difference was observed between sexes (p = 0.829), although cumulative survival was higher in females. Median survival was 13 months for patients with KPS > 70% and 8 months for those with KPS ≤ 70% ( Figure 2(B) ). Patients < 60 years had longer survival than those ≥60, but the difference was not significant (p = 0.578, Cox regression).

Survival did not differ by time to surgery (p = 0.575) or extent of resection (p = 0.575). Median survival was 20 months for patients completing the full Stupp protocol versus 7 months for incomplete treatment. On multivariate Cox regression, sex, age, preoperative KPS, Stupp protocol, extent of resection, and time to surgery showed no significant association with overall survival (p = 0.351, 0.669, 0.19, 0.83, 0.844, and 0.821, respectively).

In our series, the mean patient age was 53 years, a relatively young age that has also been reported by other authors [15] [16] . The male predominance (sex ratio, 2.1) is consistent with previous epidemiological reports [17] [18] . Intracranial hypertension, motor deficit, and seizures were the most frequent presenting symptoms, reflecting the tumor locations predominantly in the frontal and temporal lobes.

The extent of resection remains a key prognostic factor in glioblastoma management. Larger studies have consistently demonstrated improved survival with maximal safe resection [19] - [23] . In our cohort, total resection was achieved in 45% of patients; however, survival did not significantly differ according to the extent of resection. Indeed, the availability of neuroimaging modalities, neuronavigation systems, and intraoperative adjuncts (such as fluorescence-guided surgery or intraoperative monitoring) is limited, making gross total resection more difficult to achieve. The inability to consistently achieve maximal safe resection may partly explain these results [24] .

The Stupp protocol was administered in the majority of patients (84%), but only 65% completed the full course. Median survival was 20 months in patients with a complete protocol compared with 7 months in incomplete cases. This survival advantage underscores the central role of combined radiotherapy and temozolomide in glioblastoma treatment, as established by Stupp et al. [7] .

Age and KPS are well-recognized prognostic factors [11] [25] - [27] . In our series, patients younger than 60 years and those with KPS > 70% had longer survival, although the differences did not reach statistical significance. Again, this may be explained by sample size limitations and loss to follow-up.

Interestingly, survival was not influenced by the time to surgery. This suggests that, within the observed delay (2 weeks to 4 months), other factors such as tumor biology and treatment compliance may play a greater role in prognosis.

Overall, our findings confirm the importance of multimodal treatment in glioblastoma and highlight the prognostic value of functional status and completion of the Stupp protocol. The absence of statistically significant associations in multivariate analysis likely reflects the small cohort size and retrospective design, both of which limit the generalizability of our conclusions.

Glioblastoma in our series predominantly affected middle-aged men and commonly presented with intracranial hypertension, motor deficits, and seizures. Completion of the Stupp protocol was the main factor independently associated with improved survival. Although age and functional status showed strong trends toward significance in univariate analysis, these associations were not confirmed in the multivariate model, likely reflecting limited statistical power. Larger, prospective studies incorporating molecular biomarkers are needed to refine prognostic assessment and guide management strategies in our setting.