Early measures of cognitive function predict survival in patients with newly diagnosed glioblastoma
Early measures of cognitive function predict survival in patients with newly diagnosed glioblastoma
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DOI：
10.1093/neuonc/nos082
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发表时间：
2012-06-01
期刊：
影响因子：
15.9
通讯作者：
Wefel, Jeffrey S.
中科院分区：
文献类型：
--
作者：
Johnson, Derek R.;Sawyer, Allison M.;Wefel, Jeffrey S.
认知功能障碍是原发性脑肿瘤的常见表现。我们评估了一组新诊断的胶质母细胞瘤患者的早期认知功能障碍与预后之间的关系。在MD安德森神经心理学数据库中确定了91例在肿瘤切除后但在进一步治疗前完成神经心理学评估的患者。不仅使用包括年龄和KPS等临床因素的考克斯比例风险模型，还使用Kaplan-Meier方法评价认知测试表现与生存期之间的关系。手术后中位生存时间为20.7个月。认知测试的损伤率从相似性测试的7.1%到霍普金斯言语学习测试修订的总回忆的60.0%不等。作为连续变量，临床试验成套组合、连线测验B部分和控制性口头词语联想测验与生存率相关。连线测验B部分、控制性口头词汇联想、相似性和数字广度的损伤与死亡率相关。Kaplan-Meier分析证明了这些测试对整个组和通过放射治疗肿瘤学组（RTOG）递归分区分析（RPA）分类定义的选定患者亚组的生存影响。通过特定的神经心理学测试测量的认知障碍与新诊断的胶质母细胞瘤患者的预后不良独立相关，即使在RTOG RPA分类定义的患者亚组中，这种影响仍然显著。在本分析中，执行功能和注意力是与预后最密切相关的认知领域。
Cognitive dysfunction is a common manifestation of primary brain tumors. We evaluated the association between early cognitive dysfunction and prognosis in a cohort of patients with newly diagnosed glioblastoma. Ninety-one patients who completed neuropsychological assessment after tumor resection but before further treatment were identified in the MD Anderson Neuropsychology database. The relationship between performance on cognitive testing and survival was evaluated using not only Cox proportional hazards models that included clinical factors such as age and KPS but also the Kaplan-Meier method. Median survival time from surgery was 20.7 months. Rates of impairment on cognitive testing ranged from 7.1% for Similarities, to 60.0% for Hopkins Verbal Learning Test-Revised Total Recall. As continuous variables, the Clinical Trial Battery Composite, Trail Making Test Part B, and Controlled Oral Word Association test were associated with survival. Impairment on the Trail Making Test Part B, Controlled Oral Word Association, Similarities, and Digit Span were associated with mortality. Kaplan-Meier analysis demonstrated the survival impact of these tests on the group as a whole and in select patient subgroups defined by classification by the Radiation Therapy Oncology Group (RTOG) Recursive Partitioning Analysis (RPA). Cognitive impairment as measured by specific neuropsychological tests is independently associated with poor prognosis in patients with newly diagnosed glioblastoma, and this effect remains significant even within patient subgroups defined by RTOG RPA class. Executive function and attention are the cognitive domains most closely associated with prognosis in this analysis.