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Postoperative Infection May Influence Survival in Patients With Glioblastoma: Simply a Myth?

De Bonis, Pasquale MD*‡; Albanese, Alessio MD*‡; Lofrese, Giorgio MD‡; de Waure, Chiara MD§; Mangiola, Annunziato MD‡; Pettorini, Benedetta Ludovica MD‖; Pompucci, Angelo MD‡; Balducci, Mario MD¶; Fiorentino, Alba MD¶; Lauriola, Libero MD#; Anile, Carmelo MD‡; Maira, Giulio MD‡

doi: 10.1227/NEU.0b013e318222adfa
Research-Human-Clinical Studies

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.

*These authors have contributed equally to this article.

Institutes of ‡Neuro-surgery, §Hygiene, ¶Radiotherapy, and #Pathology, Catholic University School of Medicine, Rome, Italy; ‖Department of Neurosurgery, Birmingham Children's Hospital, Birmingham, England

Received, August 5, 2010.

Accepted, March 11, 2011.

Published Online, May 5, 2011.

Correspondence: Pasquale De Bonis, MD, Institute of Neurosurgery, Catholic University School of Medicine, L. go A. Gemelli, 8–00168, Rome, Italy. E-mail:

Copyright © by the Congress of Neurological Surgeons