Neurocognitive Functioning in Adult Survivors of Childhood Non-Central Nervous System Cancers
Neurocognitive Functioning in Adult Survivors of Childhood Non-Central Nervous System Cancers
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DOI：
10.1093/jnci/djq156
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发表时间：
2010-06-16
影响因子：
10.3
通讯作者：
Krull, Kevin R.
中科院分区：
文献类型：
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作者：
Kadan-Lottick, Nina S.;Zeltzer, Lonnie K.;Krull, Kevin R.
背景：我们试图测量非中枢神经系统（CNS）儿童癌症幸存者自我报告的神经认知功能，并与兄弟姐妹队列进行比较，以确定与功能恶化相关的因素。方法在一项回顾性队列研究中，5937名非中枢神经系统癌症的成年幸存者和382名兄弟姐妹完成了一项经过验证的神经心理学工具，其中包括任务效率、情绪调节、组织和记忆的子量表。将得分转换为T分；兄弟姐妹得分最差的10%（即T得分>= 63）被定义为受损。比较非中枢神经系统癌症幸存者和兄弟姐妹的多变量线性回归和对数二项回归。在幸存者中，对数二项模型评估患者和治疗因素与神经认知功能障碍的关系。所有统计检验均为双侧检验。结果：与兄弟姐妹相比，非中枢神经系统癌症幸存者在所有四个亚量表上的平均测试分数相似或略差（< 0.5标准差）。然而，受损幸存者在任务效率（13.0% vs 7.3%）、记忆（12.5% vs 7.6%）和情绪调节（21.2% vs 14.4%）方面的频率比兄弟姐妹高约50%。任务效率受损最常见于接受颅脑放射治疗的急性淋巴细胞白血病（18.1%）、接受颅脑放射治疗的髓性白血病（21.2%）和非霍奇金淋巴瘤（13.9%）。在调整分析中，诊断年龄小于6岁、女性、颅脑放射治疗和听力障碍与损伤相关。结论非中枢神经系统癌症幸存者自我报告神经认知障碍的比例在统计学和临床上都显著高于兄弟姐妹。
Background We sought to measure self-reported neurocognitive functioning among survivors of non-central nervous system (CNS) childhood cancers, overall and compared with a sibling cohort, and to identify factors associated with worse functioning.Methods In a retrospective cohort study, 5937 adult survivors of non-CNS cancers and 382 siblings completed a validated neuropsychological instrument with subscales in task efficiency, emotional regulation, organization, and memory. Scores were converted to T scores; scores in the worst 10% of siblings' scores (ie, T score >= 63) were defined as impaired. Non-CNS cancer survivors and siblings were compared with multivariable linear regression and log-binomial regression. Among survivors, log-binomial models assessed the association of patient and treatment factors with neurocognitive dysfunction. All statistical tests were two-sided.Results Non-CNS cancer survivors had similar or slightly worse (< 0.5 standard deviation) mean test scores for all four subscales than siblings. However, frequencies of impaired survivors were approximately 50% higher than siblings in task efficiency (13.0% of survivors vs 7.3% of siblings), memory (12.5% vs 7.6%), and emotional regulation (21.2% vs 14.4%). Impaired task efficiency was most often identified in patients with acute lymphoblastic leukemia who received cranial radiation therapy (18.1% with impairment), myeloid leukemia who received cranial radiation therapy (21.2%), and non-Hodgkin lymphoma (13.9%). In adjusted analysis, diagnosis age of younger than 6 years, female sex, cranial radiation therapy, and hearing impairment were associated with impairment.Conclusion A statistically and clinically significantly higher percentage of self-reported neurocognitive impairment was found among survivors of non-CNS cancers than among siblings.