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Postoperative epilepsy and survival in glioma patients: a nationwide population-based cohort study from 2009 to 2018

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Abstract

Purpose

Postoperative epilepsy is common in glioma patients and has been suggested to indicate disease progression, yet knowledge of its role as a prognostic factor is limited. This study investigates the association between postoperative epilepsy and survival amongst patients with gliomas.

Methods

We included 3763 patients with histopathologically diagnosed grade II, III, and IV gliomas from 2009 to 2018 according to the Danish Neuro-Oncology Registry. Information on epilepsy diagnosis was redeemed from the Danish National Patient Registry, the National Prescription Registry and the Danish Neuro-Oncology Registry. We used Cox proportional hazards models with 95% confidence intervals (CIs) to examine hazard ratios (HRs) for the association between postoperative epilepsy and risk of death. We examined the role of the timing of epilepsy in three different samples: Firstly, in all glioma patients with postoperative epilepsy; secondly, in patients with postoperative de novo epilepsy; thirdly, exclusively in a homogeneous sub-group of grade IV patients with postoperative de novo epilepsy.

Results

Glioma patients with postoperative epilepsy had an increased risk of death, regardless of prior epilepsy status (HR = 4.03; CI 2.69–6.03). A similar increase in the risk of death was also seen in patients with postoperative de novo epilepsy (HR = 2.08; CI 1.26–3.44) and in the sub-group of grade IV patients with postoperative de novo epilepsy (HR = 1.83; CI 1.05–3.21).

Conclusions

Postoperative epilepsy may negatively impact survival after glioma diagnosis, regardless of preoperative epilepsy status. Postoperative epilepsy may be an expression of a more invasive growth pattern of the gliomas following primary tumor treatment.

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Data accessibility

Research data was collected from Danish Health Registries and is not publicly accessible, which complies with the EU General Data Protection Regulation.

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Acknowledgements

This study was funded by grants from Nordsjællands Hospital, Helen Rudes Fond, and Tvergaards Fond.

Author information

Authors and Affiliations

  1. Department of Neurology, North Zealand Hospital, University of Copenhagen, Hilleroed, Denmark

    Mirketa Marku & Birthe Krogh Rasmussen

  2. Psychological Aspects of Cancer, Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark

    Mirketa Marku, Christoffer Johansen & Pernille Envold Bidstrup

  3. Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark

    Mirketa Marku

  4. Statistics and Data Analysis Unit, Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark

    Federica Belmonte & Elisabeth Anne Wreford Andersen

  5. Cancer Survivorship and Treatment Late Effects (CASTLE), 9601, Department of Oncology, Centre for Cancer and Organ Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark

    Christoffer Johansen

  6. Department of Psychology, University of Copenhagen, Copenhagen, Denmark

    Pernille Envold Bidstrup

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  1. Mirketa Marku
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  2. Birthe Krogh Rasmussen
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  3. Federica Belmonte
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Contributions

Design of the project: MM, BKR, and PEB. Data collection: FB, MM. Data analysis and interpretation: FB, EAWA, and MM. Writing of the manuscript: MM. Critical revision of the manuscript: BKR, PEB, FB, CJ, and EAWA. All the authors commented on and approved the final manuscript before submission.

Corresponding author

Correspondence to Mirketa Marku.

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Conflict of interest

None of the authors has any conflict of interest to disclose. The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

This is an observational study which was approved by the Danish Cancer Society (No. 2018-DCRC-0054). According to Danish legislation, since no patients were contacted for this study, no ethical approval or informed consents are required.

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Marku, M., Rasmussen, B.K., Belmonte, F. et al. Postoperative epilepsy and survival in glioma patients: a nationwide population-based cohort study from 2009 to 2018. J Neurooncol 157, 71–80 (2022). https://doi.org/10.1007/s11060-022-03948-2

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  • DOI: https://doi.org/10.1007/s11060-022-03948-2

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