Cognitive impairment three months after surgery is an independent predictor of survival time in glioblastoma patients
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CLINICAL STUDY
Cognitive impairment three months after surgery is an independent predictor of survival time in glioblastoma patients Elke Butterbrod1 · Nathalie Synhaeve2 · Geert‑Jan Rutten3 · Inga Schwabe4,5 · Karin Gehring1,3 · Margriet Sitskoorn1 Received: 16 January 2020 / Accepted: 25 June 2020 © The Author(s) 2020
Abstract Purpose Cognitive functioning is increasingly investigated for its prognostic value in glioblastoma (GBM) patients, but the association of cognitive status during early adjuvant treatment with survival time is unclear. The aim of this study was to determine whether cognitive performance three months after surgical resection predicted survival time, while using a clinically intuitive time ratio (TR) statistic. Methods Newly diagnosed patients with GBM undergoing resection between November 2010 and February 2018 completed computerized cognitive assessment 3 months after surgery with the CNS Vital Signs battery (8 measures). The association of cognitive performance (continuous Z scores and dichotomous impairment status; impaired vs. unimpaired) with survival time was assessed with multivariate Accelerated Failure Time (AFT) models that also included clinical prognostic factors and covariates related to cognitive performances. Results 114 patients were included in the analyses (median survival time 16.4 months). Of the clinical factors, postoperative Karnofsky Performance Status (TR 1.51), surgical (TR 2.20) and non-surgical (TR 1.94) salvage treatment, and pre-surgical tumor volume (cm3, TR 1.003) were significant independent predictors of survival time. Independently of the base model factors and covariates, impairment on Stroop test I and Stroop test III estimated 23% and 26% reduction of survival time (TR 0.77, TR 0.74) respectively, as compared to unimpaired performance. Conclusion These findings suggest that impaired performances on tests of executive control and processing speed in the early phase of adjuvant treatment can reflect a worse prognostic outlook rather than an early treatment effect, and their assessment might allow for early refinement of current prognostic stratification. Keywords Glioblastoma · Cognitive functioning · Survival · Karnofsky performance status · Brain tumor
Introduction
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11060-020-03577-7) contains supplementary material, which is available to authorized users. * Elke Butterbrod [email protected] 1
Department of Cognitive Neuropsychology, Tilburg University, Warandelaan 2, 5037 AB Tilburg, The Netherlands
2
Department of Neurology, Elisabeth-Tweesteden Hospital, Hilvarenbeekseweg 60, 5022 GC Tilburg, The Netherlands
3
Department of Neurosurgery, Elisabeth-Tweesteden Hospital, Hilvarenbeekseweg 60, 5022 GC Tilburg, The Netherlands
To date, functional performance status (PS) appears to be one of the few clinical factors consistently allowing for prognostic stratification in the glioblastoma (GBM) population [1–3]. Despite
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