• Katherine Hagan, Shreyas Bhavsar, Radha Arunkumar, Roxana Grasu, Anh Dang, Richard Carlson, Charles Cowles, Benjamin Arnold, Yuri Potylchansky, Thomas F Rahlfs, Ian Lipski, Caroline Walsh, Federico Jimenez, Anh T Nguyen, Lei Feng, and Juan P Cata.
• Departments of *Anesthesiology and Perioperative Medicine ‡Biostatistics, The University of Texas MD Anderson Cancer Center §Anesthesiology and Surgical Oncology Research Group, Houston, TX †Colgate University, Hamilton, NY.
• J Neurosurg Anesthesiol. 2017 Jan 1; 29 (1): 21-29.

BackgroundSeveral studies have examined the association between hyperglycemia in the first 10 to 12 weeks following surgery and postoperative survival in glioblastoma multiforme (GBM) patients. We hypothesize that episodes of hyperglycemia before, during and/or following surgery for primary GBM are independent predictors of disease progression and mortality.Materials And MethodsA total of 162 adult patients were included in the analysis. All patients received adjuvant temozolamide. The progression free survival (PFS) and overall survival (OS) rates at 1 and 5 years were analyzed using different glycemic cutoff values. Multivariate analyses were conducted to test the association between preoperative, intraoperative and postoperative hyperglycemia with PFS and OS.ResultsKaplan-Meier curves revealed a trend toward increased PFS and OS with lower glucose concentrations with the exception of glucose concentrations >180 mg/dL in the intraoperative/postoperative day 0 time period. Univariate analysis of blood glucose levels did not demonstrate a statistically significant effect on PFS in any time period, however hyperglycemia was statistically significant for OS in the preoperative time period. Although, multivariate analysis showed no statistically significant association with hyperglycemia on PFS, a statistically significant decrease in OS was seen for plasma glucose concentrations >112 mg/dL (P=0.01) and >180 mg/dL (P=0.01) in the preoperative period. There was a decreasing effect on OS with blood glucose concentrations greater than the median in multiple time periods (P=0.02).ConclusionsPreoperative hyperglycemia is associated with poor OS after GBM surgery.

14 keywords...

hide…