Cognitive Deficits and Predictors 3 Years After Diagnosis of a Pilocytic Astrocytoma in Childhood
Cognitive Deficits and Predictors 3 Years After Diagnosis of a Pilocytic Astrocytoma in Childhood
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DOI：
10.1200/jco.2008.19.6303
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发表时间：
2009-07-20
影响因子：
45.3
通讯作者：
Catsman-Berrevoets, Coriene E.
中科院分区：
文献类型：
--
作者：
Aarsen, Femke K.;Paquier, Philippe F.;Catsman-Berrevoets, Coriene E.
目的 前瞻性研究大量接受毛细胞性星形细胞瘤 (PA) 治疗的儿科患者诊断后 3 年的认知缺陷和预测因素。患者和方法 67 名儿童中的 61 名根据幕下、幕上中线和幕上半球部位进行分组。评估了智力、记忆力、注意力、语言、视觉空间和执行功能。包括的预测因素包括性别、年龄、复发、诊断-评估间隔、脑积水、治疗类型和肿瘤变量。 结果 所有 PA 儿童都存在持续注意力和速度问题。幕下组的语言智力、视觉空间记忆、执行功能和命名也存在缺陷。脑干肿瘤组出现言语智力和言语记忆问题。幕上半球肿瘤组在选择性注意力和执行功能方面存在其他问题，而幕上中线肿瘤组没有表现出额外的损伤。更具体地说，背侧幕上中线肿瘤组表现出语言和言语记忆问题。认知功能较低的预测因素包括脑积水、放射治疗、残余肿瘤大小和年龄；更好的功能的预测因素是化疗或脑积水治疗。近 60% 的儿童存在学业成绩问题，其危险因素是复发和诊断时年龄较小。 结论 尽管长期随访时智力正常，但接受 PA 治疗的儿童表现出无效的认知障碍。脑积水的充分治疗对于获得更有利的长期认知结果非常重要。即使最初没有严重缺陷的儿童也可能在诊断数年后出现认知障碍，部分原因是逐渐发展为缺陷的现象，这对学业成绩和生活质量 (QOL) 产生毁灭性影响。
Purpose To prospectively study cognitive deficits and predictors 3 years after diagnosis in a large series of pediatric patients treated for pilocytic astrocytoma (PA).Patients and Methods Sixty-one of 67 children were grouped according to infratentorial, supratentorial midline, and supratentorial hemispheric site. Intelligence, memory, attention, language, visual-spatial, and executive functions were assessed. Included predictors were sex, age, relapse, diagnosis-assessment interval, hydrocephalus, kind of treatment, and tumor variables.Results All children with PA had problems with sustained attention and speed. In the infratentorial group, there also were deficits in verbal intelligence, visual-spatial memory, executive functioning, and naming. Verbal intelligence and verbal memory problems occurred in the brainstem tumor group. The supratentorial hemispheric tumor group had additional problems with selective attention and executive functioning, and the supratentorial midline tumor group displayed no extra impairments. More specifically, the dorsal supratentorial midline tumor group displayed problems with language and verbal memory. Predictors for lower cognitive functioning were hydrocephalus, radiotherapy, residual tumor size, and age; predictors for better functioning were chemotherapy or treatment of hydrocephalus. Almost 60% of children had problems with academic achievement, for which risk factors were relapse and younger age at diagnosis.Conclusion Despite normal intelligence at long-term follow-up, children treated for PA display invalidating cognitive impairments. Adequate treatment of hydrocephalus is important for a more favorable long-term cognitive outcome. Even children without initial severe deficits may develop cognitive impairments years after diagnosis, partly because of the phenomenon of growing into deficit, which has devastating implications for academic achievement and quality of life (QOL).