Butterbrod Elke, Synhaeve Nathalie, Rutten Geert-Jan, Schwabe Inga, Gehring Karin, Sitskoorn Margriet
Department of Cognitive Neuropsychology, Tilburg University, Warandelaan 2, 5037 AB, Tilburg, The Netherlands.
Department of Neurology, Elisabeth-Tweesteden Hospital, Hilvarenbeekseweg 60, 5022 GC, Tilburg, The Netherlands.
J Neurooncol. 2020 Aug;149(1):103-111. doi: 10.1007/s11060-020-03577-7. Epub 2020 Jul 8.
Cognitive functioning is increasingly investigated for its prognostic value in glioblastoma (GBM) patients, but the association of cognitive status during early adjuvant treatment with survival time is unclear. The aim of this study was to determine whether cognitive performance three months after surgical resection predicted survival time, while using a clinically intuitive time ratio (TR) statistic.
Newly diagnosed patients with GBM undergoing resection between November 2010 and February 2018 completed computerized cognitive assessment 3 months after surgery with the CNS Vital Signs battery (8 measures). The association of cognitive performance (continuous Z scores and dichotomous impairment status; impaired vs. unimpaired) with survival time was assessed with multivariate Accelerated Failure Time (AFT) models that also included clinical prognostic factors and covariates related to cognitive performances.
114 patients were included in the analyses (median survival time 16.4 months). Of the clinical factors, postoperative Karnofsky Performance Status (TR 1.51), surgical (TR 2.20) and non-surgical (TR 1.94) salvage treatment, and pre-surgical tumor volume (cm, TR 1.003) were significant independent predictors of survival time. Independently of the base model factors and covariates, impairment on Stroop test I and Stroop test III estimated 23% and 26% reduction of survival time (TR 0.77, TR 0.74) respectively, as compared to unimpaired performance.
These findings suggest that impaired performances on tests of executive control and processing speed in the early phase of adjuvant treatment can reflect a worse prognostic outlook rather than an early treatment effect, and their assessment might allow for early refinement of current prognostic stratification.
认知功能因其在胶质母细胞瘤（GBM）患者中的预后价值而受到越来越多的研究，但早期辅助治疗期间的认知状态与生存时间之间的关联尚不清楚。本研究的目的是确定手术切除三个月后的认知表现是否能预测生存时间，同时使用临床直观的时间比（TR）统计量。
2010年11月至2018年2月期间新诊断为GBM并接受手术切除的患者在术后3个月使用中枢神经系统生命体征量表（8项测量）完成了计算机化认知评估。使用多变量加速失效时间（AFT）模型评估认知表现（连续Z分数和二分法损伤状态；受损与未受损）与生存时间之间的关联，该模型还包括临床预后因素以及与认知表现相关的协变量。
114名患者纳入分析（中位生存时间16.4个月）。在临床因素中，术后卡氏功能状态（TR 1.51）、手术（TR 2.20）和非手术（TR 1.94）挽救治疗以及术前肿瘤体积（cm，TR 1.003）是生存时间的显著独立预测因素。与未受损表现相比，独立于基础模型因素和协变量，Stroop测试I和Stroop测试III的损伤分别估计生存时间缩短23%和26%（TR 0.77，TR 0.74）。
这些发现表明，辅助治疗早期执行控制和处理速度测试中的受损表现可能反映了更差的预后前景，而非早期治疗效果，对其进行评估可能有助于早期优化当前的预后分层。
