title: Association Between Perioperative Hyperglycemia and Survival in Patients With Glioblastoma.
abstract: BACKGROUND
  Several studies have examined the association between hyperglycemia in the first 10 to 12 weeks following surgery and postoperative survival in glioblastoma multiforme (GBM) patients. We hypothesize that episodes of hyperglycemia before, during and/or following surgery for primary GBM are independent predictors of disease progression and mortality.
  
  
  METHODS
  A total of 162 adult patients were included in the analysis. All patients received adjuvant temozolamide. The progression free survival (PFS) and overall survival (OS) rates at 1 and 5 years were analyzed using different glycemic cutoff values. Multivariate analyses were conducted to test the association between preoperative, intraoperative and postoperative hyperglycemia with PFS and OS.
  
  
  RESULTS
  Kaplan-Meier curves revealed a trend toward increased PFS and OS with lower glucose concentrations with the exception of glucose concentrations >180 mg/dL in the intraoperative/postoperative day 0 time period. Univariate analysis of blood glucose levels did not demonstrate a statistically significant effect on PFS in any time period, however hyperglycemia was statistically significant for OS in the preoperative time period. Although, multivariate analysis showed no statistically significant association with hyperglycemia on PFS, a statistically significant decrease in OS was seen for plasma glucose concentrations >112 mg/dL (P=0.01) and >180 mg/dL (P=0.01) in the preoperative period. There was a decreasing effect on OS with blood glucose concentrations greater than the median in multiple time periods (P=0.02).
  
  
  CONCLUSIONS
  Preoperative hyperglycemia is associated with poor OS after GBM surgery.
authors.affiliation: Departments of *Anesthesiology and Perioperative Medicine ‡Biostatistics, The University of Texas MD Anderson Cancer Center §Anesthesiology and Surgical Oncology Research Group, Houston, TX †Colgate University, Hamilton, NY.
authors.forename: Katherine
authors.initials: K
authors.lastname: Hagan
authors.forename: Shreyas
authors.initials: S
authors.lastname: Bhavsar
authors.forename: Radha
authors.initials: R
authors.lastname: Arunkumar
authors.forename: Roxana
authors.initials: R
authors.lastname: Grasu
authors.forename: Anh
authors.initials: A
authors.lastname: Dang
authors.forename: Richard
authors.initials: R
authors.lastname: Carlson
authors.forename: Charles
authors.initials: C
authors.lastname: Cowles
authors.forename: Benjamin
authors.initials: B
authors.lastname: Arnold
authors.forename: Yuri
authors.initials: Y
authors.lastname: Potylchansky
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Rahlfs
authors.forename: Ian
authors.initials: I
authors.lastname: Lipski
authors.forename: Caroline
authors.initials: C
authors.lastname: Walsh
authors.forename: Federico
authors.initials: F
authors.lastname: Jimenez
authors.forename: Anh T
authors.initials: AT
authors.lastname: Nguyen
authors.forename: Lei
authors.initials: L
authors.lastname: Feng
authors.forename: Juan P
authors.initials: JP
authors.lastname: Cata
mesh_terms: D001932:Brain Neoplasms / Q000453:epidemiology*; D015897:Comorbidity; D005260:Female; D005909:Glioblastoma / Q000453:epidemiology*; D006801:Humans; D006943:Hyperglycemia / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D059035:Perioperative Period; D012189:Retrospective Studies; D016019:Survival Analysis