儿童脑胶质瘤成年幸存者的治疗进展、神经认知结局和功能独立性。
Evolving therapies, neurocognitive outcomes, and functional independence in adult survivors of childhood glioma.
机构信息
Department of Psychology and Biobehavioral Sciences, St. Jude Children's Research Hospital, Memphis, TN, USA.
Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA.
出版信息
J Natl Cancer Inst. 2024 Feb 8;116(2):288-298. doi: 10.1093/jnci/djad190.
BACKGROUND
Treatment of childhood glioma has evolved to reduce radiotherapy exposure with the goal of limiting late toxicity. However, the associations between treatment changes and neurocognition, and the contribution of neurocognition and chronic health conditions to attainment of adult independence, remain unknown.
METHODS
Adult survivors of childhood glioma diagnosed in 1970-1999 in the Childhood Cancer Survivor Study (n = 1284; median [minimum-maximum] 30 [18-51] years of age at assessment; 22 [15-34] years from diagnosis) self-reported neurocognitive impairment and chronic health conditions. Multivariable models evaluated associations between changes in treatment exposures (surgery only, chemotherapy [with or without surgery], cranial radiation [with or without chemotherapy and/or surgery]), and neurocognitive impairment. Latent class analysis with 5 indicators (employment, independent living, assistance with routine and/or personal care needs, driver's license, marital or partner status) identified classes of functional independence. Path analysis tested associations among treatment exposures, neurocognitive impairment, chronic health conditions, and functional independence. Statistical tests were 2-sided.
RESULTS
Cranial radiation exposure decreased over time (51%, 1970s; 46%, 1980s; 27%, 1990s]. However, compared with siblings, survivors with any treatment exposure were at elevated risk for neurocognitive impairment, including surgery only (eg, memory: relative risk = 2.22; task efficiency: relative risk = 1.88; both P < .001). Three classes of functional independence were identified: independent (58%), moderately independent (20%), and nonindependent (22%). Cranial radiation was associated with nonindependence through impaired task efficiency (β = 0.06), sensorimotor (β = 0.06), and endocrine (β = 0.10) chronic health conditions and through the associations between these conditions and task efficiency (each β = 0.04). Sensorimotor and endocrine chronic health conditions were associated with nonindependence through memory.
CONCLUSION
Most long-term glioma survivors achieve adult independence. However, functional nonindependence is associated with treatment-related neurocognitive impairment and chronic health conditions.
背景
为了限制晚期毒性，儿童脑肿瘤的治疗已发展到减少放疗暴露。然而，治疗变化与神经认知之间的关系，以及神经认知和慢性健康状况对成年独立的贡献仍然未知。
方法
接受过治疗的儿童脑肿瘤幸存者在儿童癌症幸存者研究中接受评估（n=1284；评估时的中位年龄[最小-最大]为 30[18-51]岁；诊断后 22[15-34]岁），自我报告神经认知障碍和慢性健康状况。多变量模型评估了治疗暴露（仅手术、化疗[伴有或不伴有手术]、颅部放疗[伴有或不伴有化疗和/或手术]）变化与神经认知障碍之间的关系。使用 5 个指标（就业、独立生活、日常和/或个人护理需求帮助、驾驶执照、婚姻或伴侣状况）进行潜在类别分析，确定功能独立性类别。路径分析测试了治疗暴露、神经认知障碍、慢性健康状况和功能独立性之间的关联。统计检验为双侧。
结果
颅部放疗暴露随时间减少（51%，1970 年代；46%，1980 年代；27%，1990 年代）。然而，与兄弟姐妹相比，接受任何治疗的幸存者都存在神经认知障碍的高风险，包括仅手术（例如，记忆：相对风险=2.22；任务效率：相对风险=1.88；均 P<0.001）。确定了 3 种功能独立性类别：独立（58%）、中度独立（20%）和非独立（22%）。通过受损的任务效率（β=0.06）、感觉运动（β=0.06）和内分泌（β=0.10）慢性健康状况以及这些状况与任务效率之间的关联（每个β=0.04），颅部放疗与非独立性相关。感觉运动和内分泌慢性健康状况与记忆有关，与非独立性有关。
结论
大多数长期脑肿瘤幸存者实现了成年独立。然而，功能上的不独立与治疗相关的神经认知障碍和慢性健康状况有关。
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