Yahya Ahmadipour1,2, Laurèl Rauschenbach1,2,3, Alejandro Santos1, Marvin Darkwah Oppong1,2, Lazaros Lazaridis2,4,5, Carlos M Quesada5, Andreas Junker6, Daniela Pierscianek1,2, Philipp Dammann1,2, Karsten H Wrede1,2, Björn Scheffler2,3, Martin Glas2,4,5, Martin Stuschke2,7, Ulrich Sure1,2, Ramazan Jabbarli1,2. 1. Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany. 2. German Cancer Consortium, Partner Site University Hospital Essen, Essen, Germany. 3. DKFZ-Division Translational Neurooncology at the WTZ, German Cancer Research Center (DKFZ) Heidelberg and German Cancer Consortium (DKTK) Partner Site University Hospital Essen, Essen, Germany. 4. Division of Clinical Neurooncology, Department of Neurology, University Hospital Essen, Essen, Germany. 5. Department for Neurology, University Hospital Essen, Essen, Germany. 6. Department of Neuropathology, University Hospital Essen, Essen, Germany. 7. Department of Radiotherapy, University Hospital Essen, Essen, Germany.
Abstract
BACKGROUND: Symptomatic epilepsy is a common symptom of glioblastoma, which may occur in different stages of disease. There are discrepant reports on association between early seizures and glioblastoma survival, even less is known about the background of these seizures. We aimed at analyzing the risk factors and clinical impact of perioperative seizures in glioblastoma. METHODS: All consecutive cases with de-novo glioblastoma treated at our institution between 01/2006 and 12/2018 were eligible for this study. Perioperative seizures were stratified into seizures at onset (SAO) and early postoperative seizures (EPS, ≤21days after surgery). Associations between patients characteristics and overall survival (OS) with SAO and EPS were addressed. RESULTS: In the final cohort (n = 867), SAO and EPS occurred in 236 (27.2%) and 67 (7.7%) patients, respectively. SAO were independently predicted by younger age (P = .009), higher KPS score (P = .002), tumor location (parietal lobe, P = .001), GFAP expression (≥35%, P = .045), and serum chloride at admission (>102 mmol/L, P = .004). In turn, EPS were independently associated with tumor location (frontal or temporal lobe, P = .013) and pathologic laboratory values at admission (hemoglobin < 12 g/dL, [P = .044], CRP > 1.0 mg/dL [P = 0.036], and GGT > 55 U/L [P = 0.025]). Finally, SAO were associated with gross-total resection (P = .006) and longer OS (P = .030), whereas EPS were related to incomplete resection (P = .005) and poorer OS (P = .009). CONCLUSIONS: In glioblastoma patients, SAO and EPS seem to have quite different triggers and contrary impact on treatment success and OS. The clinical characteristics of SAO and EPS patients might contribute to the observed survival differences.
BACKGROUND: Symptomatic epilepsy is a common symptom of glioblastoma, which may occur in different stages of disease. There are discrepant reports on association between early seizures and glioblastoma survival, even less is known about the background of these seizures. We aimed at analyzing the risk factors and clinical impact of perioperative seizures in glioblastoma. METHODS: All consecutive cases with de-novo glioblastoma treated at our institution between 01/2006 and 12/2018 were eligible for this study. Perioperative seizures were stratified into seizures at onset (SAO) and early postoperative seizures (EPS, ≤21days after surgery). Associations between patients characteristics and overall survival (OS) with SAO and EPS were addressed. RESULTS: In the final cohort (n = 867), SAO and EPS occurred in 236 (27.2%) and 67 (7.7%) patients, respectively. SAO were independently predicted by younger age (P = .009), higher KPS score (P = .002), tumor location (parietal lobe, P = .001), GFAP expression (≥35%, P = .045), and serum chloride at admission (>102 mmol/L, P = .004). In turn, EPS were independently associated with tumor location (frontal or temporal lobe, P = .013) and pathologic laboratory values at admission (hemoglobin < 12 g/dL, [P = .044], CRP > 1.0 mg/dL [P = 0.036], and GGT > 55 U/L [P = 0.025]). Finally, SAO were associated with gross-total resection (P = .006) and longer OS (P = .030), whereas EPS were related to incomplete resection (P = .005) and poorer OS (P = .009). CONCLUSIONS: In glioblastoma patients, SAO and EPS seem to have quite different triggers and contrary impact on treatment success and OS. The clinical characteristics of SAO and EPS patients might contribute to the observed survival differences.
Authors: Luis Castilla-Guerra; María del Carmen Fernández-Moreno; José Manuel López-Chozas; Ricardo Fernández-Bolaños Journal: Epilepsia Date: 2006-12 Impact factor: 5.864
Authors: M Weller; T Gorlia; J G Cairncross; M J van den Bent; W Mason; K Belanger; A A Brandes; U Bogdahn; D R Macdonald; P Forsyth; A O Rossetti; D Lacombe; R-O Mirimanoff; C J Vecht; R Stupp Journal: Neurology Date: 2011-08-31 Impact factor: 9.910
Authors: Christian Henker; Thomas Kriesen; Moritz Scherer; Änne Glass; Andreas von Deimling; Martin Bendszus; Marc-André Weber; Christel Herold-Mende; Andreas Unterberg; Jürgen Piek Journal: Neurosurgery Date: 2019-10-01 Impact factor: 4.654
Authors: Joseph I Sirven; Dean M Wingerchuk; Joseph F Drazkowski; Mark K Lyons; Richard S Zimmerman Journal: Mayo Clin Proc Date: 2004-12 Impact factor: 7.616
Authors: Caroline Happold; Thierry Gorlia; Olivier Chinot; Mark R Gilbert; L Burt Nabors; Wolfgang Wick; Stephanie L Pugh; Monika Hegi; Timothy Cloughesy; Patrick Roth; David A Reardon; James R Perry; Minesh P Mehta; Roger Stupp; Michael Weller Journal: J Clin Oncol Date: 2016-01-19 Impact factor: 44.544
Authors: Patrick M Flanigan; Arman Jahangiri; Ruby Kuang; Albert Truong; Sarah Choi; Alvin Chou; Jonathan W Rick; Susan M Chang; Annette M Molinaro; Michael W McDermott; Mitchel S Berger; Manish K Aghi Journal: Neurosurgery Date: 2017-11-01 Impact factor: 4.654
Authors: Christopher A Barker; Andrew J Bishop; Maria Chang; Kathryn Beal; Timothy A Chan Journal: Int J Radiat Oncol Biol Phys Date: 2013-03-20 Impact factor: 7.038
Authors: Melissa Kerkhof; Janneke C M Dielemans; Melanie S van Breemen; Hanneke Zwinkels; Robert Walchenbach; Martin J Taphoorn; Charles J Vecht Journal: Neuro Oncol Date: 2013-05-16 Impact factor: 12.300