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van Kessel E, Berendsen S, Baumfalk AE, Venugopal H, Krijnen EA, Spliet WGM, van Hecke W, Giuliani F, Seute T, van Zandvoort MJE, Snijders TJ, Robe PA. Tumor-related molecular determinants of neurocognitive deficits in patients with diffuse glioma. Neuro Oncol 2022; 24:1660-1670. [PMID: 35148403 PMCID: PMC9527514 DOI: 10.1093/neuonc/noac036] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Cognitive impairment is a common and debilitating symptom in patients with diffuse glioma, and is the result of multiple factors. We hypothesized that molecular tumor characteristics influence neurocognitive functioning (NCF), and aimed to identify tumor-related markers of NCF in diffuse glioma patients. METHODS We examined the relation between cognitive performance (executive function, memory, and psychomotor speed) and intratumoral expression levels of molecular markers in treatment-naive patients with diffuse glioma. We performed a single-center study in a consecutive cohort, through a two-step design: (1) hypothesis-free differential expression and gene set enrichment analysis to identify candidate oncogenetic markers for cognitive impairment. Nineteen molecular markers of interest were derived from this set of genes, as well as from prior knowledge; (2) correlation of cognitive performance to intratumoral expression levels of these nineteen molecular markers, measured with immunohistochemistry. RESULTS From 708 included patients with immunohistochemical data, we performed an in-depth analysis of neuropsychological data in 197, and differential expression analysis in 65 patients. After correcting for tumor volume and location, we found significant associations between expression levels of CD3 and IDH-1 and psychomotor speed; between IDH-1, ATRX, NLGN3, BDNF, CK2Beta, EAAT1, GAT-3, SRF, and memory performance; and between IDH-1, P-STAT5b, NLGN3, CK2Beta, and executive functioning. P-STAT5b, CD163, CD3, and Semaphorin-3A were independently associated after further correction for histopathological grade. CONCLUSION Molecular characteristics of glioma can be independent determinants of patients' cognitive functioning. This suggests that besides tumor volume, location, and histological grade, variations in glioma biology influence cognitive performance through mechanisms that include perturbation of neuronal communication. These results pave the way towards targeted cognition improving therapies in neuro-oncology.
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Affiliation(s)
- Emma van Kessel
- Corresponding Author: Emma van Kesssel, MD, University Medical Center Utrecht, UMC Utrecht Brain Center, Department of Neurology and Neurosurgery, internal address G03.232, PO Box 85500, 3508 XC Utrecht, The Netherlands ()
| | - Sharon Berendsen
- University Medical Center Utrecht, UMC Utrecht Brain Center, Department of Neurology & Neurosurgery, Utrecht, The Netherlands
| | - Anniek E Baumfalk
- University Medical Center Utrecht, UMC Utrecht Brain Center, Department of Neurology & Neurosurgery, Utrecht, The Netherlands
| | - Hema Venugopal
- University Medical Center Utrecht, UMC Utrecht Brain Center, Department of Neurology & Neurosurgery, Utrecht, The Netherlands
| | - Eva A Krijnen
- University Medical Center Utrecht, UMC Utrecht Brain Center, Department of Neurology & Neurosurgery, Utrecht, The Netherlands
| | - Wim G M Spliet
- University Medical Center Utrecht, Department of Pathology, Utrecht, The Netherlands
| | - Wim van Hecke
- University Medical Center Utrecht, Department of Pathology, Utrecht, The Netherlands
| | - Fabrizio Giuliani
- University Medical Center Utrecht, UMC Utrecht Brain Center, Department of Neurology & Neurosurgery, Utrecht, The Netherlands
| | - Tatjana Seute
- University Medical Center Utrecht, UMC Utrecht Brain Center, Department of Neurology & Neurosurgery, Utrecht, The Netherlands
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van Kessel E, Snijders TJ, Baumfalk AE, Ruis C, van Baarsen KM, Broekman ML, van Zandvoort MJE, Robe PA. Neurocognitive changes after awake surgery in glioma patients: a retrospective cohort study. J Neurooncol 2019; 146:97-109. [PMID: 31802314 PMCID: PMC6938472 DOI: 10.1007/s11060-019-03341-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 11/12/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE Deficits in neurocognitive functioning (NCF) frequently occur in glioma patients. Both treatment and the tumor itself contribute to these deficits. In order to minimize the harmful effects of surgery, an increasing number of patients undergo awake craniotomy. To investigate whether we can indeed preserve cognitive functioning after state-of-the art awake surgery and to identify factors determining postoperative NCF, we performed a retrospective cohort study. METHODS In diffuse glioma (WHO grade 2-4) patients undergoing awake craniotomy, we studied neurocognitive functioning both pre-operatively and 3-6 months postoperatively. Evaluation covered five neurocognitive domains. We performed analysis of data on group and individual level and evaluated the value of patient-, tumor- and treatment-related factors for predicting change in NCF, using linear and logistic regression analysis. RESULTS We included 168 consecutive patients. Mean NCF-scores of psychomotor speed and visuospatial functioning significantly deteriorated after surgery. The percentage of serious neurocognitive impairments (- 2 standard deviations) increased significantly for psychomotor speed only. Tumor involvement in the left thalamus predicted a postoperative decline in NCF for the domains overall-NCF, executive functioning and psychomotor speed. An IDH-wildtype status predicted decline for overall-NCF and executive functioning. CONCLUSIONS In all cognitive domains, except for psychomotor speed, cognitive functioning can be preserved after awake surgery. The domain of psychomotor speed seems to be most vulnerable to the effects of surgery and early postoperative therapies. Cognitive performance after glioma surgery is associated with a combination of structural and biomolecular effects from the tumor, including IDH-status and left thalamic involvement.
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Affiliation(s)
- Emma van Kessel
- Department of Neurology & Neurosurgery, University Medical Center Utrecht/UMC Utrecht Brain Center, G03.232, PO Box 85500, 3508 XC, Utrecht, The Netherlands.
| | - Tom J Snijders
- Department of Neurology & Neurosurgery, University Medical Center Utrecht/UMC Utrecht Brain Center, G03.232, PO Box 85500, 3508 XC, Utrecht, The Netherlands
| | - Anniek E Baumfalk
- Department of Neurology & Neurosurgery, University Medical Center Utrecht/UMC Utrecht Brain Center, G03.232, PO Box 85500, 3508 XC, Utrecht, The Netherlands
| | - Carla Ruis
- Department of Neurology & Neurosurgery, University Medical Center Utrecht/UMC Utrecht Brain Center, G03.232, PO Box 85500, 3508 XC, Utrecht, The Netherlands
| | - Kirsten M van Baarsen
- Department of Neurology & Neurosurgery, University Medical Center Utrecht/UMC Utrecht Brain Center, G03.232, PO Box 85500, 3508 XC, Utrecht, The Netherlands
| | - Marike L Broekman
- Department of Neurosurgery, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Martine J E van Zandvoort
- Department of Neurology & Neurosurgery, University Medical Center Utrecht/UMC Utrecht Brain Center, G03.232, PO Box 85500, 3508 XC, Utrecht, The Netherlands
- Helmhotz Institute, Utrecht University, Room 1715, Heidelberglaan 1, 3584 CS, Utrecht, The Netherlands
| | - Pierre A Robe
- Department of Neurology & Neurosurgery, University Medical Center Utrecht/UMC Utrecht Brain Center, G03.232, PO Box 85500, 3508 XC, Utrecht, The Netherlands
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Baumfalk AE, Verlaan JJ, Kasperts N, Amelink GJ, Minnema MC, Snijders TJ. [Spinal metastases: early recognition and a multidisciplinary approach]. Ned Tijdschr Geneeskd 2019; 163:D3961. [PMID: 31305960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Early diagnosis of spinal metastases is essential. The neurological condition at the time of diagnosis determines functional outcome. Optimal treatment planning requires a multidisciplinary approach by the general practitioner, internist/oncologist/haematologist, radiotherapist, radiologist, neurologist and the spinal surgeon. Radiation therapy is the most common treatment for patients with spinal metastases. However, in specific cases, surgery or chemotherapy should be the primary treatment. We present three patients with spinal metastases: a 55-year-old woman with back pain and a history of breast cancer, a 71-year-old woman with instability of the spine requiring surgical stabilisation and a 68-year-old man with spinal localisation of multiple myeloma treated with systemic therapy. Their cases illustrate the early symptoms of spinal metastases, the role of spinal stability in treatment decisions and the role of systemic therapy in patients with spinal metastases or haematological tumours located in the spine. Recognising early symptoms and appropriate multidisciplinary treatment planning are essential in improving the functional outcome in patients with spinal metastases.
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Affiliation(s)
- Anniek E Baumfalk
- UMC Utrecht Hersencentrum, afd. Neurologie en Neurochirurgie, Utrecht
| | | | | | - G J Amelink
- UMC Utrecht Hersencentrum, afd. Neurologie en Neurochirurgie, Utrecht
| | | | - Tom J Snijders
- UMC Utrecht Hersencentrum, afd. Neurologie en Neurochirurgie, Utrecht
- Contact: T.J. Snijders
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van Kessel E, Snijders TJ, Baumfalk AE, Ruis C, van Baarsen KM, Broekman ML, van Zandvoort MJE, Robe PA. P01.146 Neurocognitive changes after awake surgery for diffuse glioma; a retrospective cohort study. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- E van Kessel
- University Medical Center Utrecht, Utrecht, Netherlands
| | - T J Snijders
- University Medical Center Utrecht, Utrecht, Netherlands
| | - A E Baumfalk
- University Medical Center Utrecht, Utrecht, Netherlands
| | - C Ruis
- University Medical Center Utrecht, Utrecht, Netherlands
| | | | - M L Broekman
- Leiden University Medical Center, Leiden, Netherlands
- Haaglanden Medical Center, The Hague, Netherlands
| | - M J E van Zandvoort
- University Medical Center Utrecht, Utrecht, Netherlands
- Helmhotz Institute, Utrecht University, Utrecht, Netherlands
| | - P A Robe
- University Medical Center Utrecht, Utrecht, Netherlands
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van Kessel E, Baumfalk AE, van Zandvoort MJE, Robe PA, Snijders TJ. Tumor-related neurocognitive dysfunction in patients with diffuse glioma: a systematic review of neurocognitive functioning prior to anti-tumor treatment. J Neurooncol 2017; 134:9-18. [PMID: 28567586 PMCID: PMC5543199 DOI: 10.1007/s11060-017-2503-z] [Citation(s) in RCA: 104] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 05/20/2017] [Indexed: 11/25/2022]
Abstract
Deficits in neurocognitive functioning (NCF) frequently occur in glioma patients. Both treatment and the tumor itself contribute to these deficits. Data about the role of the tumor are scarce, because NCF has mostly been studied postoperatively. We aimed to summarize data on pre-treatment NCF in glioma patients and to determine the overall and domain-specific prevalence of neurocognitive dysfunction. We searched PubMed and Embase according to PRISMA-P protocol for studies that evaluated pre-treatment NCF in glioma patients (1995-November 2016) and extracted information about NCF. We performed analysis of data for two main outcome measures; mean cognitive functioning of the study sample (at group level) and the percentage of impaired patients (at individual level). We included 23 studies. Most studies were small observational prospective cohort studies. In 11 (47.5%) studies, patient selection was based on tumor location. NCF was analyzed at the group level in 14 studies, of which 13 (92.9%) found decreased NCF at group level, compared to normative data or matched controls. The proportion of individuals with decreased NCF was reported in 15 studies. NCF was impaired (in any domain) in 62.6% of the individuals (median; interquartile range 31.0–79.0). Cognitive impairments were more common in patients with high-grade glioma than with low-grade glioma (OR 2.50; 95% CI 1.71–3.66). Cognitive impairment occurs in the majority of treatment-naive glioma patients, suggesting that neurocognitive dysfunction is related to the tumor. However, the literature about pre-treatment NCF in glioma patients is characterized by small-scale studies and strong heterogeneity in patient selection, resulting in high risk of bias.
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Affiliation(s)
- Emma van Kessel
- Department of Neurology & Neurosurgery, University Medical Center Utrecht/Brain Center Rudolf Magnus, G03.232, PO Box 85500, 3508 XC, Utrecht, The Netherlands.
| | - Anniek E Baumfalk
- Department of Neurology & Neurosurgery, University Medical Center Utrecht/Brain Center Rudolf Magnus, G03.232, PO Box 85500, 3508 XC, Utrecht, The Netherlands
| | - Martine J E van Zandvoort
- Department of Neurology & Neurosurgery, University Medical Center Utrecht/Brain Center Rudolf Magnus, G03.232, PO Box 85500, 3508 XC, Utrecht, The Netherlands
- Helmhotz Institute, Utrecht University, Room 1715, Heidelberglaan 1, 3584 CS, Utrecht, The Netherlands
| | - Pierre A Robe
- Department of Neurology & Neurosurgery, University Medical Center Utrecht/Brain Center Rudolf Magnus, G03.232, PO Box 85500, 3508 XC, Utrecht, The Netherlands
| | - Tom J Snijders
- Department of Neurology & Neurosurgery, University Medical Center Utrecht/Brain Center Rudolf Magnus, G03.232, PO Box 85500, 3508 XC, Utrecht, The Netherlands
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Snijders TJ, Baumfalk AE, Van Zandvoort MJ, Robe PA. Neurocognitive functioning in diffuse glioma patients prior to anti-tumor treatment: A systematic review. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e13011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Tom J. Snijders
- University Medical Center Utrecht/Brain Center Rudolf Magnus, Utrecht, Netherlands
| | - Anniek E. Baumfalk
- University Medical Center Utrecht/Brain Center Rudolf Magnus, Utrecht, Netherlands
| | | | - Pierre A. Robe
- University Medical Center Utrecht/Brain Center Rudolf Magnus, Utrecht, Netherlands
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