Objectives To assess whether time to diagnosis influenced surgical procedure and survival in primary malignant brain tumours

Design Retrospective cohort study of adult patients newly diagnosed with a primary intra-cerebral tumour April 2010 – March 2015 referred to neuro-oncology centre in South-East Scotland

Subjects 400 patients with primary malignant intracerebral tumours

Methods Univariate logistic regression analysis and multivariate Cox regression survival analysis were performed

Results Our dataset included 229 Males (57.7%), mean age 62.05 (SD14.01). Time to diagnosis did affect choice of surgical procedure. Patients undergoing biopsy had significantly longer TtD than those undergoing resection (28 vs 21 days, MWU test, p=0.035). 233 (58.3%) patients were deceased at 12 months. Having a cognitive first symptom (e.g confusion/memory changes) predicted not getting any surgical procedure (OR 2.95 [95% CI 1.8–4.8]). Where surgery was performed, first cognitive symptom was not predictive of type of surgery (biopsy vs debulking/excision) (OR 1.5 [95% CI 0.8–2.9] norhaving tumour in the frontal lobe (OR 0.9 [95% CI 0.5–1.7]. In multivariate analysis, increased hazard ratio of death at 12 month was significantly associated with a cognitive first symptom (HR 1.4 [95% CI 1.0–1.9] and KPS <70 (HR 1.69 [95% CI 1.2–2.4]).

Conclusions Earlier diagnosis is associated with getting debulking surgery rather than biopsy, and patient’s presenting symptoms influence surgical decision making and outcome.