Abstract
Background: Diffuse gliomas, which are at WHO grade II-IV, are progressive primary brain tumors with great variability in prognosis. Our aim was to investigate whether pre-operative cognitive functioning is of added value in survival prediction in these patients.Methods: In a retrospective cohort study of patients undergoing awake craniotomy between 2010 and 2019 we performed pre-operative neuropsychological assessments in five cognitive domains. Their added prognostic value on top of known prognostic factors was assessed in two patient groups [low- (LGG) and high-grade gliomas (HGG]). We compared Cox proportional hazards regression models with and without the cognitive domain by means of loglikelihood ratios tests (LRT), discriminative performance measures (by AUC), and risk classification [by Integrated Discrimination Index (IDI)].Results: We included 109 LGG and 145 HGG patients with a median survival time of 1,490 and 511 days, respectively. The domain memory had a significant added prognostic value in HGG as indicated by an LRT (p-value = 0.018). The cumulative AUC for HGG with memory included was.78 (SD = 0.017) and without cognition 0.77 (SD = 0.018), IDI was 0.043 (0.000–0.102). In LGG none of the cognitive domains added prognostic value.Conclusions: Our findings indicated that memory deficits, which were revealed with the neuropsychological examination, were of additional prognostic value in HGG to other well-known predictors of survival.
Highlights
Diffuse gliomas, which are at WHO grade II-IV, are progressive primary brain tumors with a variable, but generally poor prognosis, despite recent progress in treatment options
Cognitive deficits occur in all different grades of glioma [6, 7]. We found these deficits to be independently, and possibly causally, related to survival in diffuse gliomas [8]
We focused on neurocognitive functioning (NCF) scores for five predefined cognitive domains, namely, attention and executive functioning, memory, psychomotor speed, language, and visuospatial functioning
Summary
Diffuse gliomas, which are at WHO grade II-IV, are progressive primary brain tumors with a variable, but generally poor prognosis, despite recent progress in treatment options. Frontiers in Neurology | www.frontiersin.org van Kessel et al. Cognition in the Prediction of Survival for both high- and low-grade glioma (HGG and LGG, respectively) [1,2,3,4]. For high-grade glioma, predictors include MGMT promoter methylation status and minimal mental state examination (MMSE) score [2, 5]. These prognostic factors are important to personalize treatment and rehabilitation, and to stratify patients for clinical trials. Our aim was to investigate whether preoperative cognitive functioning is of added value in survival prediction in these patients
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