Integrated clinico-radio-molecular profiling of diffuse gliomas across age groups: a Romanian single-center cohort study.

Diffuse gliomas are biologically heterogeneous primary brain tumors with variable clinical behavior, and age is a well-recognized prognostic factor; however, integrated real-world data from Eastern European populations remain limited. The aim of this study was to describe how clinical, imaging, molecular, treatment, and survival data co-vary across age groups in a Romanian tertiary neuro-oncology cohort, rather than to identify new biological associations. We conducted a single-center retrospective cohort study of 283 consecutive adult patients with histologically confirmed diffuse gliomas diagnosed between 2021 and 2024, classified according to the WHO 2021 framework. Patients were stratified into three predefined age groups (<40, 40-60, and >60 years), and clinical, histopathological, molecular, preoperative imaging, and treatment variables were compared using Pearson chi-square or Fisher exact tests; recurrence-free survival (RFS) was estimated using the Kaplan-Meier method with log-rank tests. Molecular testing availability varied across the cohort, reflecting progressive adoption of integrated molecular diagnostics. Older patients more frequently harbored IDH-wildtype glioblastoma, more aggressive imaging features, lower Karnofsky Performance Status, and received less intensive multimodal therapy. Unadjusted RFS decreased with advancing age (log-rank P < 0.001); without multivariable adjustment, this reflects the combined effects of age-correlated covariates rather than an independent age effect. This study contributes region-specific real-world evidence from an underrepresented Eastern European setting, where integrated molecular diagnostics were being progressively implemented during the study period.