Fournier-Goodnight Ashley S, Ashford Jason M, Merchant Thomas E, Boop Frederick A, Indelicato Daniel J, Wang Lei, Zhang Hui, Conklin Heather M
Department of Neuropsychology, Neurosciences, Children's Healthcare of Atlanta, Atlanta, GA, USA.
Department of Psychology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 740, Memphis, TN, 38105, USA.
J Neurooncol. 2017 Aug;134(1):97-105. doi: 10.1007/s11060-017-2492-y. Epub 2017 May 24.
The goal of this study was to investigate the impact of patient-, disease-, and treatment-related variables upon neurocognitive outcomes in pediatric patients with craniopharyngioma prior to treatment with proton therapy or observation after radical resection. For all participants (N = 104), relevant clinical and demographic variables were attained and neurocognitive evaluations completed prior to irradiation or planned observation. One-sample t-tests were conducted to compare performance to published normative data. Linear models were used to investigate predictors of performance on measures where performance was below normative expectations. Participants showed poorer performance in comparison to the normative group across neurocognitive domains including executive functions (e.g., working memory; Wechsler Digit Span Backward p = 0.03), learning and memory (e.g., California Verbal Learning Test [CVLT] Total T p = 0.00), and fine-motor coordination (e.g., Grooved Pegboard Dominant Hand p = 0.00). Poor performance across areas was predicted by presurgical hypothalamic involvement (e.g., Behavior Rating Inventory of Executive Function Working Memory Index Grade 2 β = -7.68, p = 0.03; CVLT Total T Grade 2 β = 7.94, p = 0.04; Grade 3 β = -9.80, p = 0.00), extent of surgery (e.g., CVLT Total T Resection β = -7.77, p = 0.04; Grooved Pegboard Dominant Hand β = -1.58, p = 0.04), and vision status (e.g., CVLT Total T Reduced vision without impairment β = -10.01, p = 0.02; Grooved Pegboard Dominant Hand Bilateral field defect β = -1.45, p = 0.01; Reduced vision without impairment β = -2.30, p = 0.00). This study demonstrated that patients with craniopharyngioma show weaker neurocognitive performance in comparison to the normative population resulting from tumor, events leading to diagnosis, and early surgical intervention. Systematic investigation of neurocognitive performance before treatment with radiation therapy is essential to evaluating the potential risks and benefits of newer methods of radiation therapy including proton therapy.
本研究的目的是调查在质子治疗或根治性切除术后观察之前，患者、疾病和治疗相关变量对颅咽管瘤患儿神经认知结局的影响。对于所有参与者（N = 104），在放疗或计划观察之前获取了相关临床和人口统计学变量，并完成了神经认知评估。进行单样本t检验以将表现与已发表的常模数据进行比较。对于表现低于常模预期的测量指标，使用线性模型来研究表现的预测因素。与常模组相比，参与者在包括执行功能（如工作记忆；韦氏数字广度倒背p = 0.03）、学习和记忆（如加利福尼亚言语学习测验[CVLT]总分T p = 0.00）以及精细运动协调（如槽式钉板优势手p = 0.00）在内的神经认知领域表现较差。术前下丘脑受累（如执行功能行为评定量表工作记忆指数2级β = -7.68，p = 0.03；CVLT总分T 2级β = 7.94，p = 0.04；3级β = -9.80，p = 0.00）、手术范围（如CVLT总分T切除β = -7.77，p = 0.04；槽式钉板优势手β = -1.58，p = 0.04）和视力状况（如CVLT总分T视力减退但无损害β = -10.01，p = 0.02；槽式钉板优势手双侧视野缺损β = -1.45，p = 0.01；视力减退但无损害β = -2.
