Neurocognitive status in long-term survivors of childhood CNS malignancies: a report from the Childhood Cancer Survivor Study.
Neurocognitive status in long-term survivors of childhood CNS malignancies: a report from the Childhood Cancer Survivor Study.
复制标题
DOI：
10.1037/a0016674
复制
发表时间：
2009-11
期刊：
影响因子：
2.4
通讯作者：
Zeltzer, Lonnie K.
中科院分区：
文献类型：
--
作者：
Ellenberg, Leah;Liu, Qi;Gioia, Gerard;Yasui, Yutaka;Packer, Roger J.;Mertens, Ann;Donaldson, Sarah S.;Stovall, Marilyn;Kadan-Lottick, Nina;Armstrong, Gregory;Robison, Leslie L.;Zeltzer, Lonnie K.
在儿童癌症幸存者中，中枢神经系统（CNS）恶性肿瘤患者在诊断和治疗后的头几年出现神经心理功能障碍的风险最高。本研究跟踪幸存者至成年，以评估儿童中枢神经系统恶性肿瘤及其治疗对神经认知功能的长期影响。作为儿童癌症幸存者研究（CCSS）的一部分，802名儿童中枢神经系统恶性肿瘤幸存者、5937名非中枢神经系统恶性肿瘤幸存者和382名未患癌症的兄弟姐妹在癌症诊断后至少16年完成了一份25项神经认知问卷（CCSS- ncq），评估任务效率、情绪调节、组织技能和记忆。将中枢神经系统恶性肿瘤幸存者的神经认知功能与非中枢神经系统恶性肿瘤幸存者和同胞队列进行比较。在中枢神经系统恶性肿瘤幸存者组中，采用多元线性回归评估人口统计学、疾病和治疗变量对报告的神经认知功能的贡献，以及报告的神经认知功能与教育、就业和收入状况的关系。在CCSS-NCQ评估的所有因素中，中枢神经系统恶性肿瘤幸存者报告的神经认知障碍明显大于非中枢神经系统癌症幸存者或兄弟姐妹（p< 0.01），中枢神经系统恶性肿瘤幸存者的平均T评分明显高于兄弟姐妹队列（p< 0.001），任务效率效应大（1.16），记忆效应中等（0.68）。在中枢神经系统恶性肿瘤组中，包括听力缺陷、瘫痪和脑血管事件在内的医疗并发症导致CCSS-NCQ所有因素报告缺陷的可能性更大，通常效应量较小（0.22 - 0.50）。全脑照射预测更大的任务效率和记忆损伤(效应大小：。65和。脑局部照射也是如此，但效果较小（63）。49和。分别为43)。脑室-腹膜（VP）分流放置与相同量表上的小缺陷相关（效应大小：任务效率）。记忆。32)。女性在两个量表上的得分受损的可能性更大，影响较小（任务效率）。38、情绪调节。45)，而在2岁之前诊断导致报告的记忆因素损害的可能性较小，效应大小中等（0.64）。CCSS-NCQ评分较差的中枢神经系统恶性肿瘤幸存者表现出较低的受教育程度（p< 0.01），较低的家庭收入（p< 0.001）和较少的全职就业（p< 0.001）。儿童期中枢神经系统恶性肿瘤的幸存者在成年后神经认知功能受损的风险很大，特别是如果他们接受过颅放射治疗，放置过副静脉分流术，发生过脑血管事件或留下了听力或运动障碍。报告的神经认知障碍对重要的成人结局有不利影响，包括教育、就业、收入和婚姻状况。
Among survivors of childhood cancer, those with Central Nervous System (CNS) malignancies have been found to be at greatest risk for neuropsychological dysfunction in the first few years following diagnosis and treatment. This study follows survivors to adulthood to assess the long term impact of childhood CNS malignancy and its treatment on neurocognitive functioning. As part of the Childhood Cancer Survivor Study (CCSS), 802 survivors of childhood CNS malignancy, 5937 survivors of non-CNS malignancy and 382 siblings without cancer completed a 25 item Neurocognitive Questionnaire (CCSS-NCQ) at least 16 years post cancer diagnosis assessing task efficiency, emotional regulation, organizational skills and memory. Neurocognitive functioning in survivors of CNS malignancy was compared to that of non-CNS malignancy survivors and a sibling cohort. Within the group of CNS malignancy survivors, multiple linear regression was used to assess the contribution of demographic, illness and treatment variables to reported neurocognitive functioning and the relationship of reported neurocognitive functioning to educational, employment and income status. Survivors of CNS malignancy reported significantly greater neurocognitive impairment on all factors assessed by the CCSS-NCQ than non-CNS cancer survivors or siblings (p<.01), with mean T scores of CNS malignancy survivors substantially more impaired that those of the sibling cohort (p<.001), with a large effect size for Task Efficiency (1.16) and a medium effect size for Memory (.68). Within the CNS malignancy group, medical complications, including hearing deficits, paralysis and cerebrovascular incidents resulted in a greater likelihood of reported deficits on all of the CCSS-NCQ factors, with generally small effect sizes (.22-.50). Total brain irradiation predicted greater impairment on Task Efficiency and Memory (Effect sizes: .65 and .63, respectively), as did partial brain irradiation, with smaller effect sizes (.49 and .43, respectively). Ventriculoperitoneal (VP) shunt placement was associated with small deficits on the same scales (Effect sizes: Task Efficiency .26, Memory .32). Female gender predicted a greater likelihood of impaired scores on 2 scales, with small effect sizes (Task Efficiency .38, Emotional Regulation .45), while diagnosis before age 2 years resulted in less likelihood of reported impairment on the Memory factor with a moderate effect size (.64). CNS malignancy survivors with more impaired CCSS-NCQ scores demonstrated significantly lower educational attainment (p<.01), less household income (p<.001) and less full time employment (p<.001). Survivors of childhood CNS malignancy are at significant risk for impairment in neurocognitive functioning in adulthood, particularly if they have received cranial radiation, had a VP shunt placed, suffered a cerebrovascular incident or are left with hearing or motor impairments. Reported neurocognitive impairment adversely affected important adult outcomes, including education, employment, income and marital status.
登录
查看更多内容
影响因子：
2.4
作者：
Mabbott, Donald J.;Witol, Adrienne;Bouffet, Eric
通讯作者：
Bouffet, Eric
影响因子：
45.3
作者：
Beebe, DW;Ris, MD;Wisoff, JH
通讯作者：
Wisoff, JH
影响因子：
2.4
作者：
Nagel, BJ;Delis, DC;Mulhern, RK
通讯作者：
Mulhern, RK
DOI：
10.1016/0360-3016(92)90976-o
发表时间：
1992-01-01
影响因子：
7
作者：
HALBERG, FE;KRAMER, JH;ABLIN, AR
通讯作者：
ABLIN, AR
影响因子：
4.8
作者：
ELLENBERG, L;MCCOMB, JG;STOWE, S
通讯作者：
STOWE, S