BI-17 * EARLY COGNITIVE FUNCTION TESTS PREDICT EARLY PROGRESSION IN NEWLY-DIAGNOSED GLIOBLASTOMA

Abstract

BACKGROUND: Cognitive dysfunction is a characteristic of tumor infiltration and a major morbidity causing functional deterioration in glioblastoma patients. Here we investigated whether pre-operative cognitive function tests can predict early prognosis in glioblastoma. METHODS: Consecutive patients who underwent glioma surgery were evaluated with pre-operative cognitive function tests, including Mini-Mental State Examination, Geriatric Depression Scale, Digit Span Tests (forward and backward), Controlled Oral Ward Association Test, Trail-Making Tests (TMT, type a, b, and c), and Stroop Tests. Pathologically-confirmed glioblastoma were treated with the standard protocol using radiation and temozolomide, and the 6-month progression-free survivals (PFS-6) were analyzed. RESULTS: Among 126 patients who underwent glioma surgery, 55 patients were diagnosed as glioblastoma, and 50 patients were finally eligible for the PFS-6 analysis. Thirty four patients (68%) achieved PFS-6. In the comparison of those without progression (PFS-6) with those with progression (No-PFS-6), there was no difference in the patients' demographics, tumor locations, tumor sizes, performance scores, initial symptoms, and genetic characteristics of tumors. The PFS-6 patients had higher rates of gross total resection, more use of concomitant chemo-radiation, and longer years of total education, than the no-PFS-6 patients. In the cognitive function tests, the PFS-6 patients had better performance in TMT-a, and TMT-b. Other cognitive function tests were not associated with PFS-6. In multivariate logistic regression, TMT-b was the only independent predictor for PFS-6, while age ( 12 yr), gross total resection, concomitant chemo-radiation, and TMT-a were not. Patients with good performance in TMT-b not only showed better early prognosis in the Kaplan-Meier survival analysis, but also had better recursive partitioning analysis classes. CONCLUSION: Our results indicate that the early cognitive function test before surgery can predict the early prognosis in glioblastoma. Poor executive function and slow psychomotor speed as detected in TMT suggest early progression of the tumor.