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脑肿瘤手术后功能障碍的术前非医学预测因素。

Preoperative nonmedical predictors of functional impairment after brain tumor surgery.

机构信息

Neurology, Public Health and Disability Unit, Fondazione IRCSS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy.

Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.

出版信息

Support Care Cancer. 2022 Apr;30(4):3441-3450. doi: 10.1007/s00520-021-06732-6. Epub 2022 Jan 9.

Abstract

PURPOSE

To identify the preoperative nonmedical predictors of functional impairment after brain tumor surgery.

METHODS

Patients were evaluated before brain tumor surgery and after 3 months. The cognitive evaluation included MOCA for the general cognitive status, TMT for attention and executive functions, ROWL-IR and ROWL-DR for memory, and the F-A-S for verbal fluency. Anxiety, depression, social support, resilience, personality, disability, and quality of life were evaluated with the following patient-reported outcome measures (PROMs): HADS, OSS-3, RS-14, TIPI, WHODAS-12, and EORTC-QLQ C30. Functional status was measured with KPS. Regression analyses were performed to identify preoperative nonmedical predictors of functional impairment; PROMs and cognitive tests were compared with the normative values.

RESULTS

A total of 149 patients were enrolled (64 glioma; 85 meningioma). Increasing age, lower education, higher disability, and lower ROWL-DR scores were predictors of functional impairment in glioma patients while higher TMT scores and disability were predictors in meningioma patients. In multiple regression, only a worse performance in TMT remains a predictor in meningioma patients. Cognitive tests were not significantly worse than normative values, while psychosocial functioning was impaired.

CONCLUSION

TMT could be used in the preoperative evaluation and as a potential predictor in the research field on outcome predictors. Psychosocial functioning should be studied further and considered in a clinical context to identify who need major support and to plan tailored interventions.

摘要

目的

确定脑肿瘤手术后功能障碍的术前非医学预测因素。

方法

患者在脑肿瘤手术前和术后 3 个月进行评估。认知评估包括 MOCA 用于评估总体认知状态、TMT 用于评估注意力和执行功能、ROWL-IR 和 ROWL-DR 用于评估记忆、以及 F-A-S 用于评估言语流畅性。焦虑、抑郁、社会支持、韧性、人格、残疾和生活质量采用以下患者报告结局测量(PROMs)进行评估:HADS、OSS-3、RS-14、TIPI、WHODAS-12 和 EORTC-QLQ C30。功能状态采用 KPS 进行测量。采用回归分析确定术前非医学因素对功能障碍的预测作用;将 PROMs 和认知测试与正常值进行比较。

结果

共纳入 149 例患者(64 例胶质瘤;85 例脑膜瘤)。年龄增长、教育程度较低、残疾程度较高和 ROWL-DR 评分较低是胶质瘤患者功能障碍的预测因素,而 TMT 评分较高和残疾程度较高是脑膜瘤患者功能障碍的预测因素。多元回归分析显示,只有 TMT 表现更差仍然是脑膜瘤患者的预测因素。认知测试的结果并不明显差于正常值,而心理社会功能受损。

结论

TMT 可用于术前评估,并可作为研究结果预测因素的潜在预测指标。应进一步研究心理社会功能,并在临床环境中加以考虑,以确定需要何种支持以及计划制定有针对性的干预措施。

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