Orszaghova Zuzana, Svetlovska Daniela, Vasilkova Lucia, Lesko Peter, Sycova-Mila Zuzana, Obertova Jana, Palacka Patrik, Rejlekova Katarina, Remenarova Veronika, Kalavska Katarina, Mladosievicova Beata, Mardiak Jozef, Mego Michal, Chovanec Michal
2nd Department of Oncology, Comenius University and National Cancer Institute, Bratislava, Slovakia.
Translational Research Unit, 2nd Department of Oncology, Comenius University and National Cancer Institute, Bratislava, Slovakia.
Eur Urol Oncol. 2025 Apr;8(2):460-468. doi: 10.1016/j.euo.2024.12.003. Epub 2024 Dec 18.
Survivors of testicular germ cell tumor (TGCT) may experience long-term cognitive changes. The aim of our prospective study was to longitudinally assess cognitive function among TGCT survivors to identify potential lasting cognitive changes over a period of 5 yr.
TGCT survivors (n = 151) completed Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog) questionnaires annually, with median time to first follow-up visit (FUV) of 8 (range 4-24) yr since completion of treatment. Treatment after orchiectomy included: active surveillance (AS) alone (n = 21); chemotherapy (CTx; n = 109); radiotherapy (RT) to the retroperitoneum (n = 11); and combined CTx + RT (n = 10). Scores for four FACT-Cog domains and overall cognitive scores were evaluated annually for 5 yr. In a subgroup analysis we compared results for survivors who received cisplatin at a dose of <400 mg/m (n = 48) versus ≥400 mg/m (n = 70).
The CTx + RT group had persistently lower scores for the perceived cognitive abilities (CogPCA) domain annually between the first and fifth FUVs in comparison to the AS group (all p < 0.05), with lower overall cognitive scores from the second to the fifth FUV (all p < 0.03). The group that received ≥400 mg/m cisplatin had lower CogPCA scores at the first and second FUVs, and lower overall cognitive scores at the second FUV in comparison to the AS group. However, no significant change in cognitive scores across all domains was observed over 5 yr for all survivors.
Cognitive impairment in TGCT survivors persisted over long-term follow-up. Survivors who received both CTx and RT consistently had the worst cognitive performance at all FUVs over a 5-yr period. In addition, survivors who received a higher cisplatin dose showed worse cognitive function at all FUVs.
Our study results show that survivors of testicular cancer experienced long-term cognitive dysfunction that persisted over time. Survivors who underwent both chemotherapy and radiotherapy and those who received a higher dose of chemotherapy had the worst cognitive problems.
睾丸生殖细胞肿瘤（TGCT）幸存者可能会经历长期认知变化。我们这项前瞻性研究的目的是纵向评估TGCT幸存者的认知功能，以确定在5年期间可能存在的持续性认知变化。
TGCT幸存者（n = 151）每年完成癌症治疗功能评估-认知功能（FACT-Cog）问卷，自治疗结束至首次随访（FUV）的中位时间为8年（范围4 - 24年）。睾丸切除术后的治疗包括：单纯主动监测（AS，n = 21）；化疗（CTx，n = 109）；腹膜后放疗（RT，n = 11）；以及联合化疗+放疗（n = 10）。对四个FACT-Cog领域的得分和总体认知得分进行了为期5年的年度评估。在亚组分析中，我们比较了接受顺铂剂量<400mg/m²（n = 48）与≥400mg/m²（n = 70）的幸存者的结果。
与AS组相比，化疗+放疗组在首次至第五次FUV期间每年的感知认知能力（CogPCA）领域得分持续较低（所有p < 0.05），从第二次至第五次FUV的总体认知得分也较低（所有p < 0.03）。与AS组相比，接受≥400mg/m²顺铂的组在首次和第二次FUV时CogPCA得分较低，在第二次FUV时总体认知得分较低。然而，在5年期间，所有幸存者在所有领域的认知得分均未观察到显著变化。
TGCT幸存者的认知障碍在长期随访中持续存在。接受化疗和放疗的幸存者在5年期间的所有FUV时认知表现始终最差。此外，接受较高顺铂剂量的幸存者在所有FUV时认知功能较差。
我们的研究结果表明，睾丸癌幸存者经历了长期的认知功能障碍，且这种障碍会随着时间持续存在。接受化疗和放疗的幸存者以及接受较高剂量化疗的幸存者存在最严重的认知问题。
