Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.
St. Jude Children's Research Hospital, Memphis, USA.
Eur J Cancer. 2021 May;148:103-111. doi: 10.1016/j.ejca.2021.02.010. Epub 2021 Mar 17.
To examine whether anesthesia exposure is associated with neurocognitive decline in pediatric medulloblastoma.
Patients were treated at St. Jude Children's Research Hospital and completed ≥2 protocol-directed neurocognitive assessments (n = 107) as part of a multisite clinical trial for pediatric medulloblastoma (NCT00085202). Patients received risk-adapted craniospinal photon irradiation, followed by four cycles of high-dose chemotherapy and stem cell rescue. Neurocognitive testing was completed at study baseline (after surgery and <2 weeks of starting radiation therapy) and annually for 5 years. Data on anesthesia exposure during treatment was abstracted from medical records.
Patients were 10.2 years at diagnosis on average (SD = 4.5; 37% female, 73% average-risk). Mean cumulative anesthesia duration was 20.4 h (SD = 15.2; range 0.7-55.6 h). In the overall group, longer anesthesia duration was associated with greater declines in IQ (Estimate = -0.08, P < 0.001), attention (Estimate = -0.10, P < .001) and processing speed (Estimate = -0.13, P < 0.001). Similar results were shown in subgroups of patients who were <7 years at diagnosis (IQ = -0.14, P = 0.027; Attention = -0.25: P = 0.011), ≥7 years at diagnosis (Attention = -0.07, P = 0.039; Processing Speed = -0.08, P = 0.022), treated for high-risk disease (IQ = -0.09, P = 0.024; Attention = -0.11, P = 0.034; Processing Speed = -0.13, P = 0.001), or treated for average-risk disease (IQ = -0.05, P = .022; Attention = -0.08, P = 0.011; Processing Speed = -0.10, P < 0.001).
Greater anesthesia exposure is a risk factor for clinically significant neurocognitive decline, in addition to factors of age at diagnosis and treatment risk arm. This result is notable as there are evidence-based strategies that can limit the need for anesthesia. Limiting anesthesia exposure, as feasible, may mitigate neurocognitive late effects, and thus, improve quality of life for survivors.
研究麻醉暴露是否与小儿髓母细胞瘤的神经认知能力下降有关。
患者在圣裘德儿童研究医院接受治疗，并完成了至少 2 项基于方案的神经认知评估（n=107），这是小儿髓母细胞瘤的多中心临床试验的一部分（NCT00085202）。患者接受了适应性颅脊髓光子照射，然后进行 4 个周期的高剂量化疗和干细胞挽救。神经认知测试在研究基线时（手术后和开始放射治疗不到 2 周）完成，每年进行 5 年。从病历中提取治疗期间麻醉暴露的数据。
患者诊断时的平均年龄为 10.2 岁（标准差[SD]=4.5；37%为女性，73%为低危）。平均累积麻醉时间为 20.4 小时（SD=15.2；范围 0.7-55.6 小时）。在总体组中，麻醉时间越长，智商（估计值=-0.08，P<0.001）、注意力（估计值=-0.10，P<.001）和处理速度（估计值=-0.13，P<0.001）下降越大。在诊断年龄<7 岁（智商=-0.14，P=0.027；注意力=-0.25：P=0.011）、诊断年龄≥7 岁（注意力=-0.07，P=0.039；处理速度=-0.08，P=0.022）、高危疾病治疗（智商=-0.09，P=0.024；注意力=-0.11，P=0.034；处理速度=-0.13，P=0.001）或中危疾病治疗（智商=-0.05，P=0.022；注意力=-0.08，P=0.011；处理速度=-0.10，P<0.001）的亚组中，也观察到了类似的结果。
除了诊断年龄和治疗风险臂的因素外，麻醉暴露量增加也是导致神经认知能力显著下降的一个危险因素。这一结果值得注意，因为有循证策略可以限制麻醉的需要。尽可能减少麻醉暴露可能会减轻神经认知的迟发性影响，从而提高幸存者的生活质量。
