Effects of surgery on neurocognitive function in patients with glioma: a meta-analysis of immediate post-operative and long-term follow-up neurocognitive outcomes

Ng, Justin; See, Anna; Ang, Ting Yao; Tan, Lysia Yan Rong; Ang, Beng Ti; King, Nicolas Kon Kam

doi:10.1007/s11060-018-03023-9

Cited by 57 publications

(48 citation statements)

References 50 publications

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“…Also, more than half of the patients showed stable performance over time on 6 out of the 7 domains that were assessed, suggesting that cognitive functioning does not necessarily significantly decline postsurgery. A recent meta-analysis on cognitive changes in glioma patients suggested a beneficial effect of surgery on cognitive functioning, 10 yet several studies that were excluded reported no significant declines after surgery at best, which is more in line with the current study. 12 , 20 , 41 , 42 Furthermore, another recent meta-analysis on cognitive functioning specifically in patients with GBM reported a consistently high risk of cognitive dysfunction and further deterioration of cognitive functioning after surgical treatment (with 7 out of 11 studies reporting static deficits or deteriorated performance).…”

Section: Discussionsupporting

confidence: 90%

“… 9 , 10 Previous studies show extensive preoperative, and new and worsened postoperative cognitive deficits in more than 80% of GBM patients. 6 , 10-17 Sociodemographic (ie, age, sex, and education), 18 , 19 clinical (ie, hemispheric tumor location, frontal involvement, physical health status, and tumor volume), 17-20 psychological (ie, anxiety and depression), 21 and/or cognitive (ie, preoperative neuropsychological functioning) 22 factors may play a role in predicting the outcome at 3-mo follow-up in glioma patients. However, risk factors that facilitate the identification of patients at risk for postoperative cognitive impairments already before surgery have remained unknown to date.…”

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confidence: 99%

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Presurgical Identification of Patients With Glioblastoma at Risk for Cognitive Impairment at 3-Month Follow-up

et al. 2020

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BACKGROUND Pre- and postoperative cognitive deficits have repeatedly been demonstrated in patients with glioblastoma (GBM). OBJECTIVE To identify presurgical risk factors that facilitate the identification of GBM patients at risk for postoperative cognitive impairment. METHODS Patients underwent neuropsychological assessment using Central Nervous System Vital Signs 1 d before (T0) and 3 mo after surgery (T3). Patients’ standardized scores on 7 cognitive domains were compared to a normative sample using one-sample z tests. Reliable change indices with correction for practice effects were calculated to assess cognitive changes in individual patients over time. Logistic regression models were performed to assess presurgical sociodemographic, clinical, psychological, and cognitive risk factors for postoperative cognitive impairments. RESULTS At T0, 208 patients were assessed, and 136 patients were retested at T3. Patients showed significantly lower performance both prior to and 3 mo after surgery on all cognitive domains compared to healthy controls. Improvements and declines over time occurred respectively in 11% to 32% and 6% to 26% of the GBM patients over the domains. The regression models showed that low preoperative cognitive performance posits a significant risk factor for postoperative cognitive impairment on all domains, and female sex was a risk factor for postoperative impairments in Visual Memory. CONCLUSION We demonstrated preoperative cognitive risk factors that enable the identification of GBM patients who are at risk for cognitive impairment 3 mo after surgery. This information can help to inform patients and clinicians at an early stage, and emphasizes the importance of recognizing, assessing, and actively dealing with cognitive functioning in the clinical management of GBM patients.

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Section: Discussionsupporting

confidence: 90%

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confidence: 99%

Presurgical Identification of Patients With Glioblastoma at Risk for Cognitive Impairment at 3-Month Follow-up

et al. 2020

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“…A multitude of literature suggests that employing awake mapping and monitoring techniques is particularly beneficial for glioma patients [ 16 , 17 , 31 – 33 ]. We frequently use awake surgery for tumor resection, and in our current series, more than half of the patients underwent awake craniotomy.…”

Section: Discussionmentioning

confidence: 99%

The ability to return to work: a patient-centered outcome parameter following glioma surgery

et al. 2020

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Background With refinements in diagnosis and therapy of gliomas, the importance of survival time as the sole outcome parameter has decreased, and patient-centered outcome parameters have gained interest. Pursuing a profession is an indispensable component of human happiness. The aim of this study was to analyze the professional outcomes besides their neuro-oncological and functional evaluation after surgery for gliomas in eloquent areas. Methods We assessed neuro-oncological and functional outcomes of patients with gliomas WHO grades II and III undergoing surgery between 2012 and 2018. All patients underwent routine follow-up and adjuvant treatment. Treatment and survival parameters were collected prospectively. Repercussions of the disease on the patients’ professional status, socio-economic situation, and neurocognitive function were evaluated retrospectively with questionnaires. Results We analyzed data of 58 patients with gliomas (WHO II: 9; III: 49). Median patient age was 35.8 years (range 21–63 years). Awake surgery techniques were applied in 32 patients (55.2%). Gross total and subtotal tumor resections were achieved in 33 (56.9%) and 17 (29.3%) patients, respectively, whereas in 8 patients (13.8%) resection had to remain partial. Most patients (n = 46; 79.3%) received adjuvant treatment. Median follow up was 43.8 months (range 11–82 months). After treatment 41 patients (70.7%) were able to resume a working life. Median time until returning to work was 8.0 months (range 0.2–22.0 months). To be younger than 40 at the time of the surgery was associated with a higher probability to return to work (p < .001). Multivariable regression analysis showed that patient age < 40 years as well as occupational group and self-reported fatigue were factors independently associated with the ability to return to work. Conclusion The ability to resume professional activities following brain tumor surgery is an important patient-oriented outcome parameter. We found that the majority of patients with gliomas were able to return to work following surgical and adjuvant treatment. Preservation of neurological function is of utmost relevance for individual patients´ quality of life.

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“…However, data on neurocognitive outcome after glioma surgery are less frequent and provide heterogeneous results. An effort to summarize these data has been made only recently by Ng et al, including 11 studies on a total of 313 patients, of whom 45% suffered from high grade and 55% of low grade glioma 25 . In sum, and despite the heterogeneity of data, an improvement of patients' performances was observed as early as within the first days after surgery in all cognitive domains, except for executive function that sustainably declined after surgery.…”

Section: Considerations On Neurocognitionmentioning

confidence: 99%

Benefits of glioma resection in the corpus callosum

Forster

Behrens

Lortz

et al. 2020

Sci Rep

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Due to anticipated postoperative neuropsychological sequelae, patients with gliomas infiltrating the corpus callosum rarely undergo tumor resection and mostly present in a poor neurological state. We aimed at investigating the benefit of glioma resection in the corpus callosum, hypothesizing neuropsychological deficits were mainly caused by tumor presence. Between 01/2017 and 1/2020, 21 patients who underwent glioma resection in the corpus callosum were prospectively enrolled into this study. Neuropsychological function was assessed preoperatively, before discharge and after 6 months. Gross total tumor resection was possible in 15 patients, and in 6 patients subtotal tumor resection with a tumor reduction of 97.7% could be achieved. During a median observation time of 12.6 months 9 patients died from glioblastoma after a median of 17 months. Preoperatively, all cognitive domains were affected in up to two thirds of patients, who presented a median KPS of 100% (range 60–100%). After surgery, the proportion of impaired patients increased in all neurocognitive domains. Most interestingly, after 6 months, significantly fewer patients showed impairments in attention, executive functioning, memory and depression, which are domains considered crucial for everyday functionality. Thus, the results of our study strongly support our hypothesis that in patients with gliomas infiltrating the corpus callosum the benefit of tumor resection might outweigh morbidity.

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Effects of surgery on neurocognitive function in patients with glioma: a meta-analysis of immediate post-operative and long-term follow-up neurocognitive outcomes

Cited by 57 publications

References 50 publications

Presurgical Identification of Patients With Glioblastoma at Risk for Cognitive Impairment at 3-Month Follow-up

Presurgical Identification of Patients With Glioblastoma at Risk for Cognitive Impairment at 3-Month Follow-up

The ability to return to work: a patient-centered outcome parameter following glioma surgery

Benefits of glioma resection in the corpus callosum

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