School of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, China.
Department of Anesthesiology, Jiangsu Cancer Hospital, The Affiliated Cancer Hospital of Nanjing Medical University, No. 42, Baiziting, Xuanwu District, Nanjing, 210000, Jiangsu, China.
J Cancer Res Clin Oncol. 2024 Nov 14;150(11):497. doi: 10.1007/s00432-024-06006-8.
To investigate whether neoadjuvant chemotherapy (NACT) increases the incidence of postoperative delirium (POD) in patients with gynecological tumors undergoing radical hysterectomy.
This study included 60 patients in the neoadjuvant chemotherapy exposure group and 60 in the non-exposure group. Preoperative cognitive function, the incidence of POD and other physiological parameters were assessed on preoperative day 1 (POD-1), postoperative day 1 (POD1), postoperative day 2 (POD2), and postoperative day 3 (POD3). Additionally, preoperative olfactory function was evaluated using an olfactory detection kit on POD-1. The primary outcome was the incidence of POD within three days after surgery.
The incidence of POD was 28.33% in the exposed group and 8.33% in the non-exposed group (P = 0.005). Compared to the non-exposed group, the exposed group had a higher rate of cognitive dysfunction (33.33% vs 13.33%; P = 0.010), and a higher rate of olfactory dysfunction (OD) (25.00% vs 10.00%; P = 0.031). A restricted cubic spline analysis revealed a non-linear relationship between olfactory test scores and Montreal Cognitive Assessment Scale (MoCA) scores (P for overall < 0.001, P for nonlinear = 0.001). Logistic regression identified NACT, mild and moderate cognitive dysfunction, OD, and depression as independent risk factors for POD, with all factors showing significant associations (P < 0.05). The area under the curve (AUC) of OD for predicting POD was 0.783 (95%CI 0.656-0.909).
This single-blind observational study suggests that NACT increases the incidence of POD in patients with gynecological tumors undergoing radical hysterectomy. Moreover, the results indicate that preoperative OD may reflect preoperative cognitive dysfunction, and have predictive value for the incidence of POD.
探讨新辅助化疗（NACT）是否会增加行根治性子宫切除术的妇科肿瘤患者术后谵妄（POD）的发生率。
本研究纳入了 60 例接受新辅助化疗的暴露组患者和 60 例未接受新辅助化疗的非暴露组患者。分别于术前 1 天（POD-1）、术后 1 天（POD1）、术后 2 天（POD2）和术后 3 天（POD3）评估术前认知功能、POD 的发生率和其他生理参数。此外，于 POD-1 时使用嗅觉检测试剂盒评估术前嗅觉功能。主要结局为术后 3 天内 POD 的发生率。
暴露组 POD 的发生率为 28.33%，非暴露组为 8.33%（P=0.005）。与非暴露组相比，暴露组认知功能障碍的发生率更高（33.33% vs 13.33%；P=0.010），嗅觉功能障碍的发生率也更高（25.00% vs 10.00%；P=0.031）。限制性立方样条分析显示嗅觉测试评分与蒙特利尔认知评估量表（MoCA）评分之间存在非线性关系（整体 P<0.001，非线性 P=0.001）。Logistic 回归分析确定 NACT、轻度和中度认知功能障碍、OD 和抑郁是 POD 的独立危险因素，所有因素均具有显著相关性（P<0.05）。OD 预测 POD 的曲线下面积（AUC）为 0.783（95%CI 0.656-0.909）。
本单盲观察性研究表明，NACT 会增加行根治性子宫切除术的妇科肿瘤患者 POD 的发生率。此外，结果表明术前 OD 可能反映术前认知功能障碍，并对 POD 的发生率具有预测价值。
