乌拉圭在替莫唑胺普遍可及条件下胶质母细胞瘤患者的真实世界生存结局：一项回顾性队列研究（2009-2018）及其对卫生政策的启示

Background Glioblastoma (GB) is the most aggressive primary brain tumor in adults and is traditionally associated with a poor prognosis. In 2009, Uruguay's National Resource Fund (Fondo Nacional de Recursos [FNR]) began guaranteeing universal public funding for standard temozolomide (TMZ), establishing an accessible standard of care.

This study evaluates the long-term real-world survival impact of that policy and discusses its implications for the future integration of high-cost immunotherapies. Methods We conducted a retrospective observational cohort study of adult patients with histologically confirmed supratentorial hemispheric GB who completed initial diagnosis and treatment between January 2009 and December 2017 at the Neuro-Oncology Unit of the Hospital de Cl nicas "Dr. Manuel Quintela", Montevideo, Uruguay. Follow-up extended through December 2018.

Overall survival (OS) was estimated using the Kaplan-Meier method, and the study was reported in accordance with the STROBE guidelines. Results A total of 32 patients met the inclusion criteria. Mean age was 50. 7 15. 3 years (range: 19-75 years), and 62. 5% (n = 20) were male. Gross total resection was achieved in 56. 3% of cases.

Median OS for the entire cohort was 17 months (95% CI: 7. 0-26. 9). Patients who completed the full adjuvant Stupp regimen achieved a significantly longer median OS than those with incomplete treatment (24 vs. 11 months; log-rank p = 0. 023). Conclusions Universal public funding for TMZ in Uruguay has achieved real-world outcomes consistent with international benchmarks.

However, the biological ceiling of the Stupp regimen underscores the urgent need for molecular profiling. As the therapeutic landscape shifts toward ultra-high-cost immunotherapies, establishing this historical baseline is essential for the development of sustainable, equity-driven health policies in middle-income countries.