OS08.7.A DEPRESSIVE SYMPTOMS IN ASSOCIATION WITH TUMOR LOCATIONS AT DIAGNOSIS IN PATIENTS WITH DIFFUSE GLIOMA

Abstract

Abstract BACKROUND Depressive symptoms are common in glioma patients and occur more frequent than in patients with other cancer types. The presence of tumors in specific brain regions that potentially disturb brain functions could contribute to this difference. These lesions may cause an inadequate emotional response to an incurable and lethal disease with consequences for patient counseling and neurosurgical strategies. In this study, we examine the association between brain tumor location and depressive symptoms at presentation in patients with diffuse glioma using several methods for lesion symptom mapping. MATERIAL AND METHODS The retrospective cohort consisted of patients with diffuse glioma who had a preoperative MR-scan and completed the Center for Epidemiologic Studies Depression scale (CES-D) before treatment. We classified patients based on unexpectedly low ( ≤6), intermediate (7-20) and unexpectedly high (>20) CES-D scores. Tumors were segmented in 3D and corresponding white matter disconnectomes were derived from normative tractography. We first correlated tumor and disconnectome with CES-D using sparse canonical correlation analysis to identify clusters of associated brain voxels. Next, we assessed the association between tumor locations and CES-D category using Bayesian multivariable categorical regression analysis of patient and tumor characteristics, including the overlap of tumors and disconnectomes with specific brain atlas structures, the probability of disconnection of white matter tracts, and functional network changes in local efficiency and eigenvector centrality. RESULTS We included 201 patients with a median age of 45 years (range 18-81), consisting of 62% males and 29% grade 4 gliomas. CES-D was completed a median of three weeks before surgery, was unexpectedly low in 29% and unexpectedly high in 15% of patients. Tumors located in the left (L) pallidum and right (R) thalamus were related to unexpectedly low CES-D, whereas tumors in the L hippocampus, L nucleus accumbens and R putamen were related to unexpectedly high CES-D. Disconnection of the R temporal subsection of the cingulum bundle, L optic radiation, L superior longitudinal fasciculus I and L uncinate fasciculus (UF) were related to unexpectedly low CES-D, whereas disconnection of the R corticospinal tract, R fornix, and L UF were related to unexpectedly high CES-D. Neither voxel clusters nor network measures were associated with CES-D. CONCLUSION Both unexpectedly low and unexpectedly high depressive symptom burden is common in patients with diffuse glioma at presentation. These dysfunctional emotional responses may be associated with the location of the tumor. Awareness of this phenomenon may be important in patient counseling and neurosurgical strategies. * these authors contributed equally