Introduction: There are anecdotal reports that postoperative infection may confer a survival advantage in patients with Glioblastoma multiforme (GBM). However, only a few case reports in the literature, along with two retrospective cohort studies showing some potential link between infection and prolonged survival in GBM patients.
Methods: The linked Surveillance, Epidemiology, and End Results (SEER) – Medicare database was searched to identify patients, 66 years and older with GBM with and without infection from 1997-2010. The primary outcome was survival after diagnosis. Log-rank test and multivariate analysis with the proportional hazard modeling was used to analyze the data.
Results: 3,784 patients with GBM were identified from the database, and from these, 369 patients (9.8%) had postoperative infection. In GBM patients who had an infection within one-month of surgery, there appears to be no difference in survival (5 months) compared to patients with no infection (6 months) (P=0.17). However, when looking at GBM patients with infections anytime postoperatively (not just limited to one-month postop), having an infection was associated with an improved survival of 7 months versus 5 months in patients without infection (P<0.0001). We also showed that older age, increased gagne comorbidity score, and having diabetes may be negatively associated with survival.
Conclusions: Infection after craniotomy within one-month was not associated with a survival benefit in patients with GBM, whereas infection at some point postoperatively may have some positive effect on survival. The association is by no means definitive given significant limitations to retrospective and database studies, and further studies are needed.
Patient Care: By stimulating further single and multi-center reviews on whether GBM patients with postoperative infection have improved or worse survival.
Learning Objectives: To understand the effects of infection on GBM patients
References: Bohman LE, Gallardo J, Hankinson TC, et al. The survival impact of postoperative infection in patients with glioblastoma multiforme. Neurosurgery. 2009;64(5):828-834.
Bonis PD, Albanese A, Lofrese G, et al. Postoperative infection may influence survival in patients with glioblastoma: simply a myth? Neurosurgery 69:864-869, 2011.