脑肿瘤放疗患儿的社会心理和认知功能轨迹。
Trajectories of psychosocial and cognitive functioning in pediatric patients with brain tumors treated with radiation therapy.
机构信息
Department of Psychology, St Jude Children's Research Hospital, Memphis, Tennessee.
Department of Psychology, University of Memphis, Memphis, Tennessee.
出版信息
Neuro Oncol. 2019 May 6;21(5):678-685. doi: 10.1093/neuonc/noz010.
BACKGROUND
Pediatric patients with brain tumors who are treated with radiation therapy (RT) are at risk for neurocognitive and psychosocial late effects. Research to date has primarily examined these outcomes at a group level and in isolation. Advanced statistical techniques allow for person-centered analyses, as well as examination of relationships between domain-specific trajectories.
METHODS
Patients with brain tumors (craniopharyngioma, ependymoma, low-grade astrocytoma, high-grade astrocytoma) were enrolled on a phase II clinical trial of RT. Three hundred and fifty patients completed serial neurocognitive assessments as part of their treatment monitoring, including pre-RT baseline, 6 months post-RT, and then yearly for 5 years. This secondary analysis focused on outcomes of cognition (estimated IQ, parent-reported attention problems) and psychosocial effects (parent-reported socialization and social problems) post-RT.
RESULTS
Latent growth curve modeling indicated that estimated IQ and socialization were best served by quadratic models, while attention and social problems were best served by linear models. Growth mixture modeling indicated 3-class models were the best fit for IQ and socialization, and 2-class models for attention and social problems. Baseline IQ and socialization scores were associated, but there was no association over time. Young age at diagnosis and pre-RT treatments (surgery, chemotherapy) were associated with class membership.
CONCLUSIONS
Person-centered statistical analyses provide rich information regarding the variability in neurocognitive and psychosocial functioning following RT for pediatric brain tumor. While many patients do well over time, a subset are exhibiting significant cognitive and/or psychosocial deficits. Class membership was associated with some medical factors (eg, pre-radiation surgery/chemotherapy, age at diagnosis, shunted hydrocephalus).
背景
接受放射治疗（RT）的脑肿瘤患儿存在神经认知和心理社会晚期效应的风险。迄今为止，研究主要在群体水平上孤立地检查这些结果。先进的统计技术允许进行以人为中心的分析，以及检查特定领域轨迹之间的关系。
方法
脑肿瘤（颅咽管瘤、室管膜瘤、低级别星形细胞瘤、高级别星形细胞瘤）患者参加了 RT 的 II 期临床试验。350 名患者完成了一系列神经认知评估，作为其治疗监测的一部分，包括 RT 前基线、RT 后 6 个月，然后每年进行 5 年。这项二次分析主要关注 RT 后认知（估计智商、父母报告的注意力问题）和心理社会影响（父母报告的社会化和社会问题）的结果。
结果
潜在增长曲线模型表明，估计智商和社会化最好由二次模型表示，而注意力和社会问题最好由线性模型表示。增长混合模型表明，智商和社会化的最佳拟合是 3 类模型，注意力和社会问题的最佳拟合是 2 类模型。基线智商和社会化评分相关，但随时间没有关联。诊断时年龄较小和预 RT 治疗（手术、化疗）与类别成员有关。
结论
以人为中心的统计分析为脑肿瘤儿童接受 RT 治疗后神经认知和心理社会功能的变化提供了丰富的信息。虽然许多患者随着时间的推移表现良好，但有一部分患者表现出明显的认知和/或心理社会缺陷。类别成员与一些医学因素有关（例如，放疗前手术/化疗、诊断时年龄、分流性脑积水）。
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