Postoperative infection may influence survival in patients with glioblastoma: simply a myth?
Pasquale De Bonis1, Alessio Albanese, Giorgio Lofrese
1Institutes of Neuro-surgery, Catholic University School of Medicine, Rome, Italy. debonisvox@gmail.com
Background:
It is a prevalent myth that a postoperative infection may actually confer a survival advantage in patients with malignant glioma. This contention is based largely on anecdotal reports. Recently, a single-center study showed there was no survival advantage in those patients who had glioblastoma with postoperative infection.
Objective:
To examine the impact of postoperative infections on outcome in patients with glioblastoma treated at our center.
Methods:
This study included 197 patients with newly diagnosed primary glioblastoma treated from January 2001 to January 2008. Of the 197 patients, 10 (5.08%) had postoperative bacterial infection. The Kaplan-Meier method, log-rank test, and Breslow test were used in the univariate approach; Cox regression was used in the multivariable approach.
Results:
The median survival was 16 months (95% confidence interval [CI], 14-18 mo). The infection group had a significant advantage in the median survival: 30 months (95% CI, 21-39) vs 15 months (95% CI, 13-17) for patients without postoperative infection. This advantage was also confirmed by Cox regression; in fact, patients not developing a postoperative infection showed an adjusted hazard ratio for death of 2.3 (95% CI, 1-5.3).
Conclusion:
The association between infection and prolonged survival is not definitive; we acknowledge the considerable difficulties in undertaking this type of study in a retrospective manner. Our results can instead stimulate further multicentric studies (to increase the number of patients) or experimental studies using genetically modified bacteria for treatment of glioblastoma.
Insights
Postoperative infections in glioblastoma patients may paradoxically improve survival, contrary to common belief. Further multicenter studies are needed to confirm this association and explore potential therapeutic applications.
Area of Science:
- Neuro-oncology
- Surgical outcomes
- Infectious disease
Background:
- A prevalent myth suggests postoperative infections may benefit patients with malignant glioma.
- Anecdotal reports fueled this belief, but recent single-center studies have challenged it.
- This study investigates the impact of postoperative infections on glioblastoma patient outcomes.
Purpose of the Study:
- To examine the impact of postoperative infections on patient outcomes in glioblastoma.
- To evaluate the survival advantage, if any, associated with postoperative infections in glioblastoma patients.
Main Methods:
- Retrospective analysis of 197 newly diagnosed primary glioblastoma patients (2001-2008).
- Identified 10 patients (5.08%) with postoperative bacterial infections.
- Employed Kaplan-Meier, log-rank, Breslow tests, and Cox regression for survival analysis.
Main Results:
- Median survival for all patients was 16 months.
- Patients with postoperative infection showed a significantly longer median survival of 30 months versus 15 months for uninfected patients.
- Cox regression analysis indicated an adjusted hazard ratio of 2.3 for death in patients without infection.
Conclusions:
- The association between infection and prolonged survival in glioblastoma is not definitive.
- Retrospective study limitations highlight the need for further multicenter and experimental research.
- Findings may stimulate studies on genetically modified bacteria for glioblastoma treatment.
