Long-Term Cognitive Sequelae After Pediatric Brain Tumor Related to Medical Risk Factors, Age, and Sex
Long-Term Cognitive Sequelae After Pediatric Brain Tumor Related to Medical Risk Factors, Age, and Sex
复制标题
DOI：
10.1016/j.pediatrneurol.2014.06.011
复制
发表时间：
2014-10-01
影响因子：
3.8
通讯作者：
Johanson, Aid
中科院分区：
文献类型：
--
作者：
Olsson, Ingrid Tonning;Perrin, Sean;Johanson, Aid
背景技术背景：早期诊断和颅部放射治疗是儿童脑肿瘤幸存者认知功能障碍的危险因素。其他危险因素包括脑积水、手术并发症和鞘内化疗。在一些研究中，女性对癌症治疗后认知后遗症的脆弱性已经很明显，但没有早期的研究将其与肿瘤大小相关。本研究的目的是在一个全国代表性的样本中寻找与神经心理学评估的儿童脑肿瘤患者智商降低相关的因素。方法：研究纳入了1988-2005年诊断和1995-2006年检测的69例儿童脑肿瘤患者。在一系列逐步多元回归中，评估了智商与疾病、治疗和个体变量（性别和综合征）的关系。对性别和肿瘤大小之间的协变进行了亚组分析。结果：患者普遍存在智商低下，执行功能、记忆力和注意力受损。低智商与诊断时的年龄、男性、肿瘤大小和全脑放射治疗有关。诊断时颅内压升高的患者性别差异明显，男性肿瘤较大。肿瘤大小被认为是一个更好的预测认知后遗症比性别。结论：全脑放射治疗、大肿瘤、诊断时年龄小和男性是儿童脑肿瘤后晚期认知后遗症的危险因素。在检查性别差异时，需要考虑诊断时的肿瘤大小。
BACKGROUND: Young age at diagnosis and treatment with cranial radiation therapy are well studied risk factors for cognitive impairment in pediatric brain tumor survivors. Other risk factors are hydrocephalus, surgery complications, and treatment with intrathecal chemotherapy. Female gender vulnerability to cognitive sequelae after cancer treatment has been evident in some studies, but no earlier studies have related this to tumor size. The purpose of our study was to find factors correlated with lowered IQ in a nationally representative sample of pediatric brain tumor patients referred for neuropsychologic evaluation. METHODS: Sixty-nine pediatric brain tumor patients, diagnosed 1988-2005 and tested 1995-2006, were included in the study. In a series of stepwise multiple regressions, the relationship of IQ to disease, treatment, and individual variables (sex and syndromes) were evaluated. A subanalysis was made of the covariation between sex and tumor size. RESULTS: The patients had generally suppressed IQ and impairments in executive function, memory, and attention. Lowered IQ was associated with young age at diagnosis, being male, tumor size, and treatment with whole-brain radiation therapy. A sex difference was evident for patients with increased intracranial pressure at diagnosis with males having larger tumors. Tumor size was found to be a better predictor of cognitive sequelae than sex. CONCLUSIONS: Whole-brain radiation therapy, large tumors, young age at diagnosis, and male gender are risk factors for late cognitive sequelae after pediatric brain tumors. When examining sex differences, tumor size at diagnosis needs to be taken into account.