gms | German Medical Science

Objective: Overall survival (OS) is known to be improved by an increased extent of reseciton (EOR), but radicality in resection can cause complications. Data on glioblastoma (GBM) patients and MGMT status is missing so far. Objective of the present study was to evaluate the influence of perioperative complications on OS in relation to the MGMT status in glioblastoma patients.

Methods: 269 consecutive patients treated with gross total (64%) or subtotal resection (36%) between 2014 and 2017 with GBM were included in the study. Patient data, including patient characteristics, histological diagnosis, EOR, immediate new neurological deficits postoperative and perioperative complications were entered into a computerized database. Perioperative complications were defined as new ischemia on MRI, any new hematoma, edema, meningitis, deep venous thrombosis, pulmonary embolism, myocardial infarctions, wound healing disturbances and cerebrospinal fluid leakage. Immediate new neurological deficits included confusion, motor weakness, sensory deficits, language difficulties, visual deficits and ataxia.

Results: The median OS was 12 months. 24% had perioperative complications. 19% had immediate new neurological deficits. Using Kaplan-Meier estimation, OS was significantly decreased in patients with perioperative complications, independent of the MGMT status (positive p=0.02 versus negative p=0.001). In contrast, OS was decreased in patients with negative MGMT status, but not in patients with positive MGMT status (p=0.03 versus p=0.4). In a multivariate analysis, age (p=0.007), and perioperative complications (p=0.03) were significantly associated with overall survival.

Conclusion: Overall survival was reduced in all patients with perioperative complications independent of the MGMT status. But looking at all patients with immediate new neurological deficits after glioma surgery a decreased OS was found only in the MGMT negative GBM patients.