Højris Niels Fog, Frederiksen Yoon, Agerbæk Mads, Nielsen Solvej Heeringa, Holt Mick, Brand Signe Lehn, Petersen Nikoline Lysemose, Knudsen Ulla Breth, Amidi Ali
Fertility Clinic, University Clinic Horsens, Horsens, Denmark.
Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
Support Care Cancer. 2025 Jun 17;33(7):591. doi: 10.1007/s00520-025-09637-w.
Research shows that testicular cancer patients (TCPs) evidence cognitive impairment (CI) in the absence of systemic therapy, suggesting that the cancer itself or surgery may play a role. In the present study, we undertook longitudinal cognitive assessments in TCPs from pre- to post-orchiectomy.
Enrolled TCPs underwent cognitive assessment with the Cambridge Neuropsychological Test Automated Battery prior to orchiectomy (T1) and 9 months later (T2). Test outcomes were norm-adjusted and converted to z scores. A mean global composite score (GCS) across all tests was calculated. A standardized regression-based approach was used for the longitudinal analyses. Biological markers, including lactate dehydrogenase (LDH) and alpha-fetoprotein (AFP), were also assessed.
Of 48 eligible patients, 29 (60%) participated and 20 (69%) underwent follow-up assessment. Mean z scores (SD) at pre-orchiectomy ranged from - 0.16 (0.73) to 0.53 (0.76). GCS was 0.26 (0.64) with three TCPs (10.3%) evidencing clinically significant CI. Mean standardized change z scores from pre- to post-orchiectomy ranged from - 0.42 (0.87) to 0.67 (0.76). A statistically significant decrease in GCS was observed from T1 to T2 (p = .03). Statistically significant associations were observed between LDH and several cognitive domains (r's = - .48 to - .52), and between AFP and executive function (r = - .44).
Overall, the prevalence of CI was low, and cognitive performance from pre- to post-orchiectomy was within a normative range. However, a decrease in overall cognitive function was noted, and a possible association was observed between cognitive performance and LDH and AFP.
gov Identifier: NCT03880994.
研究表明，睾丸癌患者（TCPs）在未接受全身治疗的情况下存在认知障碍（CI），这表明癌症本身或手术可能起了作用。在本研究中，我们对TCPs从睾丸切除术前到术后进行了纵向认知评估。
纳入的TCPs在睾丸切除术前（T1）和9个月后（T2）接受了剑桥神经心理测试自动成套测验的认知评估。测试结果进行了常模调整并转换为z分数。计算了所有测试的平均总体综合得分（GCS）。纵向分析采用基于标准化回归的方法。还评估了包括乳酸脱氢酶（LDH）和甲胎蛋白（AFP）在内的生物学标志物。
48名符合条件的患者中，29名（60%）参与，20名（69%）接受了随访评估。睾丸切除术前的平均z分数（标准差）范围为-0.16（0.73）至0.53（0.76）。GCS为0.26（0.64），3名TCPs（10.3%）有临床显著的CI。从睾丸切除术前到术后的平均标准化变化z分数范围为-0.42（0.87）至0.67（0.76）。从T1到T2观察到GCS有统计学显著下降（p = 0.03）。观察到LDH与几个认知领域之间有统计学显著关联（r值 = -0.48至-0.52），以及AFP与执行功能之间有统计学显著关联（r = -0.44）。
总体而言，CI的患病率较低，睾丸切除术前到术后的认知表现处于正常范围内。然而，注意到总体认知功能有所下降，并且观察到认知表现与LDH和AFP之间可能存在关联。
美国国立医学图书馆临床试验注册中心标识符：NCT03880994。
