Cognitive impairment three months after surgery is an independent predictor of survival time in glioblastoma patients

Elke Butterbrod*, Nathalie Synhaeve, Geert-Jan Rutten, Inga Schwabe, Karin Gehring, Margriet Sitskoorn

*Corresponding author for this work

Research output: Contribution to journalArticleScientificpeer-review

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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.
Original languageEnglish
Number of pages9
JournalJournal of Neuro-Oncology
DOIs
Publication statusE-pub ahead of print - 2020

Keywords

  • ADULT PATIENTS
  • AGE
  • Brain tumor
  • CLASSIFICATION
  • Cognitive functioning
  • DYSFUNCTION
  • EXECUTIVE FUNCTION
  • Glioblastoma
  • Karnofsky performance status
  • PERFORMANCE
  • PROCESSING SPEED
  • PROGNOSTIC-FACTOR
  • Survival
  • TEST-B
  • TUMOR

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