Department of Neuroscience, University of Padova, Italy; Padova Neuroscience Center (PNC), University of Padova, Italy.
Padova Neuroscience Center (PNC), University of Padova, Italy; Department of Information Engineering, University of Padova, Italy.
Neuroimage Clin. 2022;36:103219. doi: 10.1016/j.nicl.2022.103219. Epub 2022 Oct 3.
Gliomas are commonly characterized by neurocognitive deficits that strongly impact patients' and caregivers' quality of life. Surgical resection is the mainstay of therapy, and it can also cause cognitive impairment. An important clinical problem is whether patients who undergo surgery will show post-surgical cognitive impairment above and beyond that present before surgery. The relevant rognostic factors are largely unknown. This study aims to quantify the cognitive impairment in glioma patients 1-week after surgery and to compare different pre-surgical information (i.e., cognitive performance, tumor volume, grading, and lesion topography) towards predicting early post-surgical cognitive outcome. We retrospectively recruited a sample of N = 47 patients affected by high-grade and low-grade glioma undergoing brain surgery for tumor resection. Cognitive performance was assessed before and immediately after (∼1 week) surgery with an extensive neurocognitive battery. Multivariate linear regression models highlighted the combination of predictors that best explained post-surgical cognitive impairment. The impact of surgery on cognitive functioning was relatively small (i.e., 85% of test scores across the whole sample indicated no decline), and pre-operative cognitive performance was the main predictor of early post-surgical cognitive outcome above and beyond information from tumor topography and volume. In fact, structural lesion information did not significantly improve the accuracy of prediction made from cognitive data before surgery. Our findings suggest that post-surgery neurocognitive deficits are only partially explained by preoperative brain damage. The present results suggest the possibility to make reliable, individualized, and clinically relevant predictions from relatively easy-to-obtain information.
神经胶质瘤通常表现为神经认知缺陷,严重影响患者和护理人员的生活质量。手术切除是主要的治疗方法,也会导致认知障碍。一个重要的临床问题是,接受手术的患者是否会出现术后认知障碍,超过术前存在的认知障碍。相关的预后因素在很大程度上尚不清楚。本研究旨在量化胶质瘤患者手术后 1 周的认知障碍,并比较不同的术前信息(即认知表现、肿瘤体积、分级和病变部位),以预测早期术后认知结果。我们回顾性招募了 47 名患有高级别和低级别胶质瘤的患者,他们因肿瘤切除而行脑部手术。在手术前后(约 1 周)使用广泛的神经认知测试对认知表现进行评估。多元线性回归模型突出了预测术后认知障碍的最佳预测因子组合。手术对认知功能的影响相对较小(即整个样本中有 85%的测试分数表明没有下降),术前认知表现是术后早期认知结果的主要预测因素,超过了肿瘤部位和体积的信息。事实上,结构性病变信息并不能显著提高术前认知数据预测的准确性。我们的研究结果表明,术后神经认知缺陷仅部分由术前脑损伤引起。这些结果表明,可以根据相对容易获得的信息进行可靠、个性化和具有临床相关性的预测。
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