Longitudinal assessment of cognitive function in testicular cancer patients prior to orchiectomy and 9 months later and associations with tumor markers.

PURPOSE

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.

METHODS

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.

RESULTS

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).

CONCLUSION

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.

CLINICALTRIALS

gov Identifier: NCT03880994.