The effect of postoperative infection on survival in patients with glioblastoma

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OBJECTIVE

Glioblastoma is a primary glial neoplasm with a median survival of approximately 1 year. There are anecdotal reports that postoperative infection may confer a survival advantage in patients with glioblastoma. However, only a few case reports in the literature, along with 2 retrospective cohort studies, show some potential link between infection and prolonged survival in patients with glioblastoma. The objective of this study was to evaluate the effect of postoperative infection in patients with glioblastoma using a large national database.

METHODS

The linked Surveillance, Epidemiology, and End Results (SEER)–Medicare database was searched to identify patients 66 years of age and older with glioblastoma, with and without infection, from 1997 to 2010. The primary outcome was survival after diagnosis. The statistical analysis was performed with a graphical representation using Kaplan-Meier curves, univariate analysis with the log-rank test, and multivariate analysis with proportional hazards modeling.

RESULTS

A total of 3784 patients with glioblastoma were identified from the database, and from these, 369 (9.8%) had postoperative infection within 1 month of surgery. In patients with glioblastoma who had an infection within 1 month of surgery, there was no significant difference in survival (median 5 months) compared with patients with no infection (median 6 months; p = 0.17). The study also showed that older age, increased Gagne comorbidity score, and having diabetes may be negatively associated with survival.

CONCLUSIONS

Infection after craniotomy within 1 month was not associated with a survival benefit in patients with glioblastoma.

ABBREVIATIONS CI = confidence interval; HCMV = human cytomegalovirus; HR = hazard ratio; IQR = interquartile range; KPS = Karnofsky Performance Scale; MGMT = O6-methylguanine-DNA methyltransferase; SEER = Surveillance, Epidemiology, and End Results.

Article Information

Correspondence Stephen Skirboll, Department of Neurosurgery, Stanford University Medical Center, 300 Pasteur Dr., R200, Palo Alto, CA 94304. email: skirboll@stanford.edu.

INCLUDE WHEN CITING Published online December 9, 2016; DOI: 10.3171/2016.8.JNS16836.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

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    Kaplan-Meier (KM) survival curve showing the effect of infection within 1 month of surgery. IQR = Q1–Q3. Figure is available in color online only.

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