Article
Impact of inflammation and Staphylococcus infection on survival of glioblastoma patients
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Authors
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Susanne Grube
- Universitätsklinikum Jena - Klinik für Neurochirurgie, Jena, Deutschland
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Christian Ewald
- Städtisches Klinikum Brandenburg GmbH - Klinik für Neurochirurgie, Brandenburg an der Havel, Deutschland
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Rolf Kalff
- Universitätsklinikum Jena - Klinik für Neurochirurgie, Jena, Deutschland
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Jan Walter
- Klinik für Neurochirurgie, Universitätsklinikum Jena, Universitätsklinikum Jena, Jena, Deutschland
| Published: | June 9, 2017 |
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Outline
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Objective: It is still a prevalent assumption that a postoperative infection may confer a survival advantage in patients with glioblastoma multiforme. The neurosurgical literature contains some anecdotal reports of patients with malignant gliomas who experienced prolonged overall survival after a bacterial infection. This association has been analyzed before in two single-center studies in glioblastoma patients with postoperative infections, but with controversial results. We examined the impact of postoperative inflammation with or without bacterial infection on outcome in patients with glioblastoma.
Methods: A single-center analysis of patients with newly diagnosed primary glioblastoma treated from January 2004 to December 2015 has been performed. A total of 334 patients were examined. Twenty four patients (7.2%) had postoperative complications in terms of inflammation; out of these fifteen (62.5%) had a bacterial infection, ten (41.7%) with Staphylococci. Survival differences in comparison to a control group were evaluated using Kaplan-Meier curves. Other prognostic factors were analyzed in a Cox proportional hazards regression model.
Results: The selected sample was represented by 79 patients (50 men, 29 women; mean age 63 years, range 30-83). The median survival was 9 months (95% confidence interval, 6.8 -11.2 months). The inflammation group and Staphylococcus group had significant advantages in the median survival: 11 months (95% CI, 6.2 -15.8, log-rank test p=.028) and 14 months (95% CI, 6.3 -27.9, log-rank test p=.006). In contrast, the infection group, which includes all bacterial infections occurred, showed no significant survival advantage. The added Cox regression model showed that patients who did not develop postoperative infection and not underwent tumor progress were significantly at risk of death.
Conclusion: In this study, postoperative infection did confer a survival advantage in patients with glioblastoma multiforme. The median survival was not as impressive as shown by De Bonis and colleagues before. Because of the survival advantage in the inflammation group it can be assumed that there is an association with stimulated immune response.
