title: Persistent outpatient hyperglycemia is independently associated with survival, recurrence and malignant degeneration following surgery for hemispheric low grade gliomas.
abstract: 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.
authors: Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD 21231, USA.
authors: Kaisorn L
authors: KL
authors: Chaichana
authors: Matthew J
authors: MJ
authors: McGirt
authors: Graeme F
authors: GF
authors: Woodworth
authors: Ghazala
authors: G
authors: Datoo
authors: Rafael J
authors: RJ
authors: Tamargo
authors: John
authors: J
authors: Weingart
authors: Alessandro
authors: A
authors: Olivi
authors: Henry
authors: H
authors: Brem
authors: Alfredo
authors: A
authors: Quinones-Hinojosa
mesh_terms: 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
chemical_list: D001786:Blood Glucose