Persistent outpatient hyperglycemia is independently associated with survival, recurrence and malignant degeneration following surgery for hemispheric low grade gliomas.
OBJECTIVE
Hyperglycemia has been shown to augment tumor growth in vitro. However, the effects of persistent hyperglycemia on survival, recurrence and malignant degeneration in patients undergoing surgery for low grade gliomas remain unknown.


METHODS
All patients who underwent a craniotomy for hemispheric low grade glioma (WHO grade II) from 1996 to 2006 at a single institution were retrospectively reviewed. Persistent hyperglycemia was defined as serum glucose >180 microg/dl occurring three or more times between 1 and 3 months post-operatively. The independent association of outpatient glucose levels and recorded clinical and treatment variables with overall survival, tumor recurrence and malignant degeneration was assessed via separate multivariate proportional-hazards regression analyses.


RESULTS
In this study, 182 patients (89 fibrillary astrocytomas, 82 oligodendrogliomas and 11 mixed gliomas) were available for analysis. Eighteen (10%) patients experienced persistent hyperglycemia. Patients experiencing persistent hyperglycemia were older (44 +/- 16 versus 34 +/- 15) and more frequently diabetic [3 (17%) versus 4 (2%)]. All other clinical and treatment variables were not significantly different between the two cohorts. After adjusting for inter-group differences including age and diabetes and variables associated with survival and recurrence, persistent hyperglycemia was independently associated with decreased survival (p=0.001), increased recurrence (p=0.0001) and increased malignant degeneration (p<0.0001). This remained true after excluding all patients with diabetes and those on continued steroid administration. Five-year overall survival, progression-free survival and malignancy-free survival for persistent hyperglycemia versus relatively euglycemic cohorts were 43% versus 84%, 16% versus 46% and 46% versus 77%, respectively.


CONCLUSIONS
These findings may provide useful insight for increasing survival, decreasing tumor recurrence and decreasing malignant degeneration in patients undergoing surgery for low grade gliomas.
Chaichana
Kaisorn L
KL
Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD 21231, USA.
McGirt
Matthew J
MJ
Woodworth
Graeme F
GF
Datoo
Ghazala
G
Tamargo
Rafael J
RJ
Weingart
John
J
Olivi
Alessandro
A
Brem
Henry
H
Quinones-Hinojosa
Alfredo
A
D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D001932:Brain Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D018450:Disease Progression; D005260:Female; D005910:Glioma / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D006801:Humans; D006943:Hyperglycemia / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000473:pathology; D009410:Nerve Degeneration / Q000209:etiology / Q000473:pathology / Q000601:surgery; D015996:Survival Rate; D055815:Young Adult
D001786:Blood Glucose