Cancer Res Treat.  2020 Apr;52(2):586-593. 10.4143/crt.2019.242.

Risk Factors for Cognitive Impairment in High-Grade Glioma PatientsTreated with Postoperative Radiochemotherapy

• Wang Q
• Xiao F
• Qi F
• Song X
• Yu Y

• KMID: 2500343
• DOI: http://doi.org/10.4143/crt.2019.242

Abstract

Purpose
Fractionated radiotherapy as well as concomitant and adjuvant chemotherapy such as temozolomide for postoperative high-grade glioma (HGG) patients improves progressionfree survival and overall survival. Multiple factors such as chemotherapy, radiotherapy, tumor grade, residual tumor volume, and genetic modifications might play a role in the formation of cognitive impairment. The risk factors of cognitive impairment in postoperative patients with HGG receiving radiotherapy and chemotherapy remains a concern in this population. The purpose of this study was to identify risk factors for cognitive impairment in patients of postoperative HGG.
Materials and Methods
A total of 229 patients with HGG who underwent surgery were analyzed. Cognitive impairment was defined as a decrease of Cognitive Assessment Montreal (MoCA)’s score in at least two cognitive domains or any MoCA’s score of less than 26 points at the time of study compared with baseline level. Multiple potential risk factors including methylated status of the O6-methylguanine-DNA methyltransferase (MGMT) promoter, glioma World Health Organization (WHO) grade, residual tumor volume, education, and sex were analyzed. Cox univariate and multivariate regression analysis was used to detect the significant risk factors for cognitive impairment.
Results
At the end of follow-up among the 229 patients, 147 patients (67%) developed cognitive impairment. 82 patients (36%) remained in normal cognitive condition. In multivariate analysis, unmethylated MGMT promoter (hazard ratio [HR], 1.679; 95% confidence interval [CI], 1.212 to 2.326; p=0.002), glioblastoma (HR, 1.550; 95% CI, 1.117 to 2.149; p=0.009), and residual tumor volume > 5.58 cm3 (HR, 1.454; 95% CI, 1.047 to 2.020; p=0.026) were independent risk factors for cognitive impairment.
Conclusion
Methylated status of the MGMT promoter, glioma WHO grade, and residual tumor volume might be risk factors for the cognitive impairment in postoperative patients with HGG.

Keyword

Risk factors; Cognitive dysfunction; High-grade glioma; Radiotherapy; Chemotherapy

Figure

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  Fig. 1. Flowchart of the study. HGG, high-grade glioma; MoCA, Cognitive Assessment Montreal; MRI, magnetic resonance imaging.

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  Fig. 2. The incidence of cognitive impairment in the cohort (n=229) presented in a survival plot.

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  Fig. 3. Cognitive impairment curves for the independent predictors. (A) O6-methylguanine-DNA methyltransferase (MGMT) promoter methylation status of high-grade glioma (HGG). (B) HGG. (C) Residual tumor volume of HGG.

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  Fig. 4. Discrimination for risk prediction model of cognitive impairment by receiver operating characteristic curve.

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  Fig. 5. Calibration of cognitive impairment risk model.

Reference

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