Persistent outpatient hyperglycemia is independently associated with survival, recurrence and malignant degeneration following surgery for hemispheric low grade gliomas

Kaisorn L. Chaichana, Matthew J. McGirt, Graeme F. Woodworth, Ghazala Datoo, Rafael J. Tamargo, John Weingart, Alessandro Olivi, Henry Brem, Alfredo Quinones-Hinojosa

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Objective: Hyperglycemia has been shown to augment tumor growth in vitro. However, the effects of persistent hyperglycemia on survival, recurrence and malignant degeneration in patients undergoing surgery for low grade gliomas remain unknown. Methods: All patients who underwent a craniotomy for hemispheric low grade glioma (WHO grade II) from 1996 to 2006 at a single institution were retrospectively reviewed. Persistent hyperglycemia was defined as serum glucose >180 μg/dl occurring three or more times between 1 and 3 months post-operatively. The independent association of outpatient glucose levels and recorded clinical and treatment variables with overall survival, tumor recurrence and malignant degeneration was assessed via separate multivariate proportional-hazards regression analyses. Results: In this study, 182 patients (89 fibrillary astrocytomas, 82 oligodendrogliomas and 11 mixed gliomas) were available for analysis. Eighteen (10%) patients experienced persistent hyperglycemia. Patients experiencing persistent hyperglycemia were older (44 ± 16 versus 34 ± 15) and more frequently diabetic [3 (17%) versus 4 (2%)]. All other clinical and treatment variables were not significantly different between the two cohorts. After adjusting for inter-group differences including age and diabetes and variables associated with survival and recurrence, persistent hyperglycemia was independently associated with decreased survival (p=0·001), increased recurrence (p=0·0001) and increased malignant degeneration (p<0·0001). This remained true after excluding all patients with diabetes and those on continued steroid administration. Five-year overall survival, progression-free survival and malignancy-free survival for persistent hyperglycemia versus relatively euglycemic cohorts were 43% versus 84%, 16% versus 46% and 46% versus 77%, respectively. Discussion: These findings may provide useful insight for increasing survival, decreasing tumor recurrence and decreasing malignant degeneration in patients undergoing surgery for low grade gliomas.

Original languageEnglish (US)
Pages (from-to)442-448
Number of pages7
JournalNeurological Research
Volume32
Issue number4
DOIs
StatePublished - May 1 2010
Externally publishedYes

Fingerprint

Glioma
Hyperglycemia
Outpatients
Recurrence
Survival
Neoplasms
Oligodendroglioma
Glucose
Craniotomy
Astrocytoma
Disease-Free Survival
Steroids
Regression Analysis
Therapeutics
Growth
Serum

Keywords

  • Hyperglycemia
  • Low grade gliomas
  • Malignancy
  • Recurrence
  • Survival

ASJC Scopus subject areas

  • Medicine(all)
  • Neurology
  • Clinical Neurology

Cite this

Persistent outpatient hyperglycemia is independently associated with survival, recurrence and malignant degeneration following surgery for hemispheric low grade gliomas. / Chaichana, Kaisorn L.; McGirt, Matthew J.; Woodworth, Graeme F.; Datoo, Ghazala; Tamargo, Rafael J.; Weingart, John; Olivi, Alessandro; Brem, Henry; Quinones-Hinojosa, Alfredo.

In: Neurological Research, Vol. 32, No. 4, 01.05.2010, p. 442-448.

Research output: Contribution to journalArticle

Chaichana, Kaisorn L. ; McGirt, Matthew J. ; Woodworth, Graeme F. ; Datoo, Ghazala ; Tamargo, Rafael J. ; Weingart, John ; Olivi, Alessandro ; Brem, Henry ; Quinones-Hinojosa, Alfredo. / Persistent outpatient hyperglycemia is independently associated with survival, recurrence and malignant degeneration following surgery for hemispheric low grade gliomas. In: Neurological Research. 2010 ; Vol. 32, No. 4. pp. 442-448.
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T1 - Persistent outpatient hyperglycemia is independently associated with survival, recurrence and malignant degeneration following surgery for hemispheric low grade gliomas

AU - Chaichana, Kaisorn L.

AU - McGirt, Matthew J.

AU - Woodworth, Graeme F.

AU - Datoo, Ghazala

AU - Tamargo, Rafael J.

AU - Weingart, John

AU - Olivi, Alessandro

AU - Brem, Henry

AU - Quinones-Hinojosa, Alfredo

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N2 - Objective: Hyperglycemia has been shown to augment tumor growth in vitro. However, the effects of persistent hyperglycemia on survival, recurrence and malignant degeneration in patients undergoing surgery for low grade gliomas remain unknown. Methods: All patients who underwent a craniotomy for hemispheric low grade glioma (WHO grade II) from 1996 to 2006 at a single institution were retrospectively reviewed. Persistent hyperglycemia was defined as serum glucose >180 μg/dl occurring three or more times between 1 and 3 months post-operatively. The independent association of outpatient glucose levels and recorded clinical and treatment variables with overall survival, tumor recurrence and malignant degeneration was assessed via separate multivariate proportional-hazards regression analyses. Results: In this study, 182 patients (89 fibrillary astrocytomas, 82 oligodendrogliomas and 11 mixed gliomas) were available for analysis. Eighteen (10%) patients experienced persistent hyperglycemia. Patients experiencing persistent hyperglycemia were older (44 ± 16 versus 34 ± 15) and more frequently diabetic [3 (17%) versus 4 (2%)]. All other clinical and treatment variables were not significantly different between the two cohorts. After adjusting for inter-group differences including age and diabetes and variables associated with survival and recurrence, persistent hyperglycemia was independently associated with decreased survival (p=0·001), increased recurrence (p=0·0001) and increased malignant degeneration (p<0·0001). This remained true after excluding all patients with diabetes and those on continued steroid administration. Five-year overall survival, progression-free survival and malignancy-free survival for persistent hyperglycemia versus relatively euglycemic cohorts were 43% versus 84%, 16% versus 46% and 46% versus 77%, respectively. Discussion: These findings may provide useful insight for increasing survival, decreasing tumor recurrence and decreasing malignant degeneration in patients undergoing surgery for low grade gliomas.

AB - Objective: Hyperglycemia has been shown to augment tumor growth in vitro. However, the effects of persistent hyperglycemia on survival, recurrence and malignant degeneration in patients undergoing surgery for low grade gliomas remain unknown. Methods: All patients who underwent a craniotomy for hemispheric low grade glioma (WHO grade II) from 1996 to 2006 at a single institution were retrospectively reviewed. Persistent hyperglycemia was defined as serum glucose >180 μg/dl occurring three or more times between 1 and 3 months post-operatively. The independent association of outpatient glucose levels and recorded clinical and treatment variables with overall survival, tumor recurrence and malignant degeneration was assessed via separate multivariate proportional-hazards regression analyses. Results: In this study, 182 patients (89 fibrillary astrocytomas, 82 oligodendrogliomas and 11 mixed gliomas) were available for analysis. Eighteen (10%) patients experienced persistent hyperglycemia. Patients experiencing persistent hyperglycemia were older (44 ± 16 versus 34 ± 15) and more frequently diabetic [3 (17%) versus 4 (2%)]. All other clinical and treatment variables were not significantly different between the two cohorts. After adjusting for inter-group differences including age and diabetes and variables associated with survival and recurrence, persistent hyperglycemia was independently associated with decreased survival (p=0·001), increased recurrence (p=0·0001) and increased malignant degeneration (p<0·0001). This remained true after excluding all patients with diabetes and those on continued steroid administration. Five-year overall survival, progression-free survival and malignancy-free survival for persistent hyperglycemia versus relatively euglycemic cohorts were 43% versus 84%, 16% versus 46% and 46% versus 77%, respectively. Discussion: These findings may provide useful insight for increasing survival, decreasing tumor recurrence and decreasing malignant degeneration in patients undergoing surgery for low grade gliomas.

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KW - Low grade gliomas

KW - Malignancy

KW - Recurrence

KW - Survival

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