Updated CNS tumour epidemiology in Southeast Asia may guide future studies

A study in Singapore has provided a comprehensive update of the epidemiology of brain and spinal tumours managed surgically, helping guide future research on central nervous system (CNS) tumours.

The most common histological types of tumours were metastases, meningiomas, tumours of the sellar region, nerve sheath tumours, and high-grade gliomas, while those of brain and spine tumours were metastases and nerve sheath tumours, respectively.

“However, our study involved only one institution and hence may not be representative of the epidemiology of brain and spinal tumours in our country,” the researchers said.

Five hundred one patients who underwent surgery for brain or spinal tumours from 2016 to 2020 were included in this single-centre retrospective review. Participants were eligible if they had a brain or spinal tumour that was histologically verified and if they were aged 18 years and above at the time of surgery.

Of the patients, 435 (86.8 percent) had brain tumours and 66 (13.2 percent) had spinal tumours. Participants with brain tumours usually presented with cranial nerve palsy, headache, and weakness, while those with spinal tumours normally had weakness, numbness, and back pain. [Singapore Med J 2025;66:545-550]

Metastases, meningiomas, and tumours of the sellar region were found to be the most common histological types of brain and spinal tumours overall. Moreover, common complications following surgery included cerebrospinal fluid leak, diabetes insipidus, and urinary tract infection.

Notably, recurrence occurred in 15.2 percent of brain tumours and in 13.6 percent of spinal tumours, while 25.7 percent and 18.2 percent of patients with brain and spinal tumours died, respectively. In addition, survival was worst and recurrence rates were highest among those with high-grade gliomas and metastases.

“High-grade gliomas and metastases had the poorest survival and highest recurrence rates and may therefore benefit from more specialized attention, such as from palliative care physicians, where indicated,” the researchers said.

International cohorts

In previous studies, other international surgical cohorts showed incidence of metastases, meningiomas, and tumours of the sellar region ranging from 4 percent to 12 percent, 21 percent to 26 percent, and 1.8 percent to 22 percent. [CNS Oncol 2020;9:CNS55; J Nepal Health Res Counc 2020;18:219-223; PLoS One 2017;12:e0174439; Salud Publica Mex 2016;58:171-178]

“The incidence of meningiomas and tumours of the sellar region at our institution falls within the range of the incidences reported by other surgical cohorts,” the researchers said. “However, our institution had a considerably higher incidence of metastases.”

Furthermore, patients with grade I or II gliomas were younger (mean age 29.0 and 40.5 years, respectively) than those with other histological types of brain or spinal tumour (mean age 48.4‒63.3 years). In the present cohort, the mean age of patients with grade I or II gliomas falls within the range of other international surgical cohorts (21.9‒39 and 33.6‒47 years, respectively).

“Tumours of the brain and spine are rare,” the researchers said. “In Southeast Asia, the incidence rates of benign and malignant brain and spinal tumours were 6.97 and 3.29 per 100,000 person-years, respectively.” [J Clin Neurosci 2019;66:121-127]