Pierre A Robe1, Martine J E van Zandvoort1,2, Tom J Snijders1, Emma van Kessel3, Irene M C Huenges Wajer1,2, Carla Ruis1,2, Tatjana Seute1, Susanne Fonville1, Filip Y F L De Vos4, Joost J C Verhoeff1,5. 1. Department of Neurology and Neurosurgery, University Medical Center Utrecht/UMC Utrecht Brain Center, G03.232, PO Box 85500, 3508 XC, Utrecht, The Netherlands. 2. Experimental Psychology, Helmholtz Institute, Utrecht University, Heidelberglaan 1, 3584 CS, Utrecht, The Netherlands. 3. Department of Neurology and Neurosurgery, University Medical Center Utrecht/UMC Utrecht Brain Center, G03.232, PO Box 85500, 3508 XC, Utrecht, The Netherlands. e.vankessel-2@umcutrecht.nl. 4. Department of Medical Oncology, University Medical Center Utrecht/UMC Utrecht Brain Center, Q05.4.300, PO Box 85500, 3508 XC, Utrecht, The Netherlands. 5. Department of Radiation Oncology, University Medical Center Utrecht, HP Q 00.3.11, 3508 GA, Utrecht, The Netherlands.
Abstract
BACKGROUND: Diffuse gliomas (WHO grade II-IV) are progressive primary brain tumors with great variability in prognosis. Cognitive deficits are of important prognostic value for survival in diffuse gliomas. Until now, few studies focused on domain-specific neuropsychological assessment and rather used MMSE as a measure for cognitive functioning. Additionally, these studies did not take WHO 2016 diagnosis into account. We performed a retrospective cohort study with the aim to investigate the independent relationship between cognitive functioning and survival in treatment-naive patients undergoing awake surgery for a diffuse glioma. METHODS: In patients undergoing awake craniotomy between 2010 and 2017, we performed pre-operative neuropsychological assessments in five cognitive domains, with special attention for the domains executive functioning and memory. We evaluated the independent relation between these domains and survival, in a Cox proportional hazards model that included state-of-the-art integrated histomolecular ('layered' or WHO-2016) classification of the gliomas and other known prognostic factors. RESULTS: We included 197 patients. Cognitive impairments (Z-values ≦ - 2.0) were most frequent in the domains memory (18.3%) and executive functioning (25.9%). Impairments in executive functioning and memory were significantly correlated with survival, even after correcting for the possible confounders. Analyses with the domains language, psychomotor speed, and visuospatial functioning yielded no significant results. Extensive domain-specific neuropsychological assessment was more strongly correlated to survival than MMSE. CONCLUSION: Cognitive functioning is independently related to survival in diffuse glioma patients. Possible mechanisms underlying this relationship include the notion of cognitive functioning as a marker for diffuse infiltration of the tumor and the option that cognitive functioning and survival are determined by overlapping genetic pathways and biomarkers.
BACKGROUND: Diffuse gliomas (WHO grade II-IV) are progressive primary brain tumors with great variability in prognosis. Cognitive deficits are of important prognostic value for survival in diffuse gliomas. Until now, few studies focused on domain-specific neuropsychological assessment and rather used MMSE as a measure for cognitive functioning. Additionally, these studies did not take WHO 2016 diagnosis into account. We performed a retrospective cohort study with the aim to investigate the independent relationship between cognitive functioning and survival in treatment-naive patients undergoing awake surgery for a diffuse glioma. METHODS: In patients undergoing awake craniotomy between 2010 and 2017, we performed pre-operative neuropsychological assessments in five cognitive domains, with special attention for the domains executive functioning and memory. We evaluated the independent relation between these domains and survival, in a Cox proportional hazards model that included state-of-the-art integrated histomolecular ('layered' or WHO-2016) classification of the gliomas and other known prognostic factors. RESULTS: We included 197 patients. Cognitive impairments (Z-values ≦ - 2.0) were most frequent in the domains memory (18.3%) and executive functioning (25.9%). Impairments in executive functioning and memory were significantly correlated with survival, even after correcting for the possible confounders. Analyses with the domains language, psychomotor speed, and visuospatial functioning yielded no significant results. Extensive domain-specific neuropsychological assessment was more strongly correlated to survival than MMSE. CONCLUSION: Cognitive functioning is independently related to survival in diffuse gliomapatients. Possible mechanisms underlying this relationship include the notion of cognitive functioning as a marker for diffuse infiltration of the tumor and the option that cognitive functioning and survival are determined by overlapping genetic pathways and biomarkers.
Authors: Ellen M P van Loon; Majanka H Heijenbrok-Kal; Wouter S van Loon; Martin J van den Bent; Arnaud J P E Vincent; Inge de Koning; Gerard M Ribbers Journal: J Rehabil Med Date: 2015-06 Impact factor: 2.912
Authors: Francesco Pignatti; Martin van den Bent; Desmond Curran; Channa Debruyne; Richard Sylvester; Patrick Therasse; Denes Afra; Philippe Cornu; Michel Bolla; Charles Vecht; Abul B M F Karim Journal: J Clin Oncol Date: 2002-04-15 Impact factor: 44.544
Authors: Thierry Gorlia; Martin J van den Bent; Monika E Hegi; René O Mirimanoff; Michael Weller; J Gregory Cairncross; Elizabeth Eisenhauer; Karl Belanger; Alba A Brandes; Anouk Allgeier; Denis Lacombe; Roger Stupp Journal: Lancet Oncol Date: 2007-12-21 Impact factor: 41.316
Authors: Emma van Kessel; Anniek E Baumfalk; Martine J E van Zandvoort; Pierre A Robe; Tom J Snijders Journal: J Neurooncol Date: 2017-05-31 Impact factor: 4.130
Authors: Emma van Kessel; Michelle A C Emons; Irene H Wajer; Kirsten M van Baarsen; Marike L Broekman; Pierre A Robe; Tom J Snijders; Martine J E Van Zandvoort Journal: Neurooncol Pract Date: 2019-04-22
Authors: Sam T Creavin; Susanna Wisniewski; Anna H Noel-Storr; Clare M Trevelyan; Thomas Hampton; Dane Rayment; Victoria M Thom; Kirsty J E Nash; Hosam Elhamoui; Rowena Milligan; Anish S Patel; Demitra V Tsivos; Tracey Wing; Emma Phillips; Sophie M Kellman; Hannah L Shackleton; Georgina F Singleton; Bethany E Neale; Martha E Watton; Sarah Cullum Journal: Cochrane Database Syst Rev Date: 2016-01-13
Authors: Pierre A Robe; Matea Rados; Wim G Spliet; Reinier G Hoff; Peter Gosselaar; Marike L D Broekman; Martine J van Zandvoort; Tatjana Seute; Tom J Snijders Journal: Front Oncol Date: 2022-03-09 Impact factor: 6.244
Authors: Emma van Kessel; Eva A Krijnen; Suzanne IJpelaar; Irene M C Huenges Wajer; Carla Ruis; Tatjana Seute; Filip Y F L De Vos; Joost J C Verhoeff; Pierre A Robe; Martine J E van Zandvoort; Tom J Snijders Journal: Neurooncol Pract Date: 2022-04-05