Schagen Sanne B, Boogerd Willem, Muller Martin J, Huinink Wim Ten Bokkel, Moonen Luc, Meinhardt Wim, Van Dam Frits S A M
Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
Acta Oncol. 2008;47(1):63-70. doi: 10.1080/02841860701518058.
There is growing concern that some cytotoxic regimens for cancer affect cognitive functioning. This study examined the prevalence of cognitive complaints and deficits in testicular cancer (TC) patients treated with the worldwide standard BEP (bleomycin, etoposide and cisplatin) chemotherapy.
Seventy TC patients treated with BEP chemotherapy after surgery (S + CT) were examined with interviews and neuropsychological tests. These patients were compared with 57 TC patients treated with radiotherapy after surgery (S + RT) and with 55 TC patients that received surgery only (S). Patients were examined a median of 3 years after completion of treatment.
Thirty two percent of the S + CT patients reported cognitive complaints compared with 32% of the S + RT patients and 27% of the S patients (p = 0.85). No differences in mean cognitive test performance were observed between the groups. On individual impairment scores, more S + CT patients showed cognitive dysfunction compared with S patients, but not compared with S + RT patients (S + CT versus S [p = 0.038, OR = 4.6, CI = 1.1-19.7], S + CT versus S + RT [p = 0.70, OR = 0.8, CI = 0.3-2.4] and S + RT versus S [p = 0.070, OR = 3.7, CI = 0.8-15.7). Cognitive complaints were not related to cognitive test performance, but to emotional distress and fatigue.
Cognitive complaints are common among TC patients, independent of treatment modality. These complaints are related to emotional distress and fatigue and not to formal cognitive deficits. The finding of a small group of TC patients treated with chemotherapy exhibiting cognitive deficits should be confirmed in a prospective study before we can decide on its cause and relevance.
人们越来越担心某些癌症细胞毒性治疗方案会影响认知功能。本研究调查了采用全球标准的博来霉素、依托泊苷和顺铂（BEP）化疗方案治疗的睾丸癌（TC）患者出现认知主诉和认知缺陷的情况。
对70例术后接受BEP化疗（手术 + 化疗，S + CT）的TC患者进行访谈和神经心理学测试。将这些患者与57例术后接受放疗（手术 + 放疗，S + RT）的TC患者以及55例仅接受手术（S）的TC患者进行比较。患者在完成治疗后中位3年接受检查。
32%的S + CT患者报告有认知主诉，S + RT患者为32%，S组患者为27%（p = 0.85）。各研究组之间在认知测试平均表现上未观察到差异。在个体损伤评分方面，与S组患者相比，更多S + CT患者表现出认知功能障碍，但与S + RT组患者相比则无差异（S + CT组与S组比较：p = 0.038，OR = 4.6，CI = 1.1 - 19.7；S + CT组与S + RT组比较：p = 0.70，OR = 0.8，CI = 0.3 - 2.4；S + RT组与S组比较：p = 0.070，OR = 3.7，CI = 0.8 - 15.7）。认知主诉与认知测试表现无关，而是与情绪困扰和疲劳有关。
认知主诉在TC患者中很常见，与治疗方式无关。这些主诉与情绪困扰和疲劳有关，而非正式的认知缺陷。一小部分接受化疗的TC患者出现认知缺陷这一发现，在我们确定其原因和相关性之前，应在前瞻性研究中得到证实。
