title: The effect of postoperative infection on survival in patients with glioblastoma.
abstract: 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.
authors.affiliation: Department of Neurosurgery, Stanford University, Palo Alto, California.
authors.forename: Yi-Ren
authors.initials: YR
authors.lastname: Chen
authors.affiliation: Departments of 2 Neurosurgery.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Ugiliweneza
authors.affiliation: Neurology, and.
authors.forename: Eric
authors.initials: E
authors.lastname: Burton
authors.affiliation: Radiation Oncology, University of Louisville, Kentucky; and.
authors.forename: Shiao Y
authors.initials: SY
authors.lastname: Woo
authors.affiliation: Departments of 2 Neurosurgery.
authors.forename: Maxwell
authors.initials: M
authors.lastname: Boakye
authors.affiliation: Department of Neurosurgery, Stanford University, Palo Alto, California.|Section of Neurosurgery, VA Palo Alto Health Care System, Palo Alto, California.
authors.forename: Stephen
authors.initials: S
authors.lastname: Skirboll
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000401:mortality* / Q000601:surgery*; D005260:Female; D005909:Glioblastoma / Q000401:mortality* / Q000601:surgery*; D006801:Humans; D007239:Infections / Q000401:mortality*; D008297:Male; D011183:Postoperative Complications / Q000401:mortality*; D012189:Retrospective Studies; D015996:Survival Rate
keywords: 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; SEER Medicare database; glioblastoma; oncology; outcome; postoperative infection