Background/Objectives: Glioblastoma IDH-wildtype CNS WHO grade 4 and astrocytoma IDH-mutant WHO grade 4 (together, high-grade gliomas: HGGs) are the most prevalent malignant brain tumors, carrying a poor prognosis despite multimodal treatment. Surgical site infections (SSIs) represent a relative frequent postoperative complication in HGG patients. Despite multimodal treatment protocols combining surgery, radiotherapy, and temozolomide chemotherapy, HGGs remain associated with a dismal prognosis, underscoring the need to evaluate how SSIs impact disease progression and survival outcomes. This study’s aim was to investigate the influence of SSIs on the clinical course of patients with HGGs. Methods: A comprehensive review of medical records for HGG patients treated at our institution between 2010 and 2024 identified 26 patients with SSIs. These patients were compared to an age-matched control group with the same histological diagnosis and treatment regimen. This study analyzed overall survival (OS), microbiological data, and pathological parameters to assess the impact of SSIs on patient outcomes. Survival differences between the infected and non-infected groups were evaluated using Kaplan–Meier survival curves. Remarkably, three patients with exceptionally long overall survival were highlighted in this study. Results: Among the cohort of 2008 patients with HGG surgery, 26 patients developed SSIs. An age-matched control group of 26 patients was identified, none of whom experienced SSIs. Comparing the OS between the infected and uninfected groups, a statistically significant improvement in OS was observed in the infected group (p= 0.049). The median OS in the infected group was 388 days, slightly shorter than the median OS of 422 days in the control group. However, the mean OS was markedly higher in the infected group (674 days) compared to the control group (442 days). The standard deviation of OS in the infected group was notably expansive, indicating substantial variability in survival outcomes. A cluster of infected patients with SSIs near the time of diagnosis had shorter OS, while other infected cases demonstrated significantly longer survival, exceeding both median and mean OS values. In contrast, the uninfected group showed limited standard deviation values, with uniformly distributed individual OS data around the median and mean values. Expectedly, IDH mutation status significantly influenced the survival in cohort patients. However, when stratified by infection status, no association between IDH mutation and improved infection-related survival was identified. The microbiological profile of SSIs was diverse, encompassing Gram-positive and Gram-negative bacteria as well as aerobic and anaerobic organisms. Conclusions: These findings underscore the heterogeneity of infection-related outcomes and their potential impact on survival in HGG patients. According to our knowledge, our study is one of the largest retrospective studies to date investigating and confirming the significant relationship between SSIs and HGG patients’ survival. Our results confirm the Janus Face phenomenon of infections, having both negative and positive effects depending on the context.
背景/目的：IDH野生型胶质母细胞瘤（CNS WHO 4级）和IDH突变型星形细胞瘤（WHO 4级）（合称高级别胶质瘤）是最常见的恶性脑肿瘤，尽管采用多模式治疗，其预后仍然很差。手术部位感染是HGG患者相对常见的术后并发症。尽管采用了结合手术、放疗和替莫唑胺化疗的多模式治疗方案，HGG的预后依然很差，这凸显了评估SSI如何影响疾病进展和生存结果的必要性。本研究旨在探讨SSI对HGG患者临床病程的影响。方法：通过对2010年至2024年间在我院接受治疗的HGG患者病历进行全面回顾，确定了26例发生SSI的患者。将这些患者与具有相同组织学诊断和治疗方案的年龄匹配对照组进行比较。本研究分析了总生存期、微生物学数据和病理学参数，以评估SSI对患者结局的影响。使用Kaplan-Meier生存曲线评估感染组与非感染组之间的生存差异。值得注意的是，本研究重点介绍了三名总生存期异常长的患者。结果：在2008例接受HGG手术的患者队列中，有26例患者发生了SSI。确定了由26例患者组成的年龄匹配对照组，该组患者均未发生SSI。比较感染组与未感染组的总生存期，发现感染组的OS有统计学意义上的改善（p=0.049）。感染组的中位OS为388天，略短于对照组的422天。然而，感染组的平均OS（674天）显著高于对照组（442天）。感染组OS的标准差明显较大，表明生存结果存在显著变异性。在诊断时间附近发生SSI的一组感染患者OS较短，而其他感染病例则表现出显著更长的生存期，超过了中位和平均OS值。相比之下，未感染组的标准差值有限，个体OS数据围绕中位值和平均值均匀分布。不出所料，IDH突变状态显著影响了队列患者的生存期。然而，当按感染状态分层时，未发现IDH突变与改善的感染相关生存期之间存在关联。SSI的微生物学谱多样，包括革兰氏阳性菌和革兰氏阴性菌，以及需氧菌和厌氧菌。结论：这些发现强调了感染相关结局的异质性及其对HGG患者生存的潜在影响。据我们所知，我们的研究是迄今为止规模最大的回顾性研究之一，调查并证实了SSI与HGG患者生存期之间的显著关系。我们的结果证实了感染的"双面神"现象，即根据具体情况，感染可能产生负面或正面影响。
肿瘤(癌症)患者之家