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Long-Term Disease Burden and Survivorship Issues After Surgery and Radiotherapy of Intracranial Meningioma Patients
Neurosurgery ( IF 3.9 ) Pub Date : 2020-08-20 , DOI: 10.1093/neuros/nyaa351
Amir H Zamanipoor Najafabadi 1, 2 , Pim B van der Meer 2 , Florien W Boele 3, 4 , Martin J B Taphoorn 2, 5 , Martin Klein 6 , Saskia M Peerdeman 7 , Wouter R van Furth 1 , Linda Dirven 2, 5 ,
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Abstract BACKGROUND Many intracranial meningioma patients have an impaired health-related quality of life (HRQoL) and neurocognitive functioning up to 4 yr after intervention. OBJECTIVE To assess the long-term (≥5 yr) disease burden of meningioma patients. METHODS In this multicenter cross-sectional study, patients ≥5 yr after intervention (including active magnetic resonance imaging (MRI) surveillance) were included and assessed for HRQoL (Short-Form Health Survey 36), neurocognitive functioning (neuropsychological assessment), anxiety and depression (Hospital Anxiety and Depression Scale), and work productivity (Short Form-Health and Labour Questionnaire). Multivariable and propensity score regression analyses were used to compare patients and controls, and different treatment strategies corrected for possible confounders. Clinically relevant differences were reported. RESULTS At a median of 9 yr follow-up after intervention, meningioma patients (n = 190) reported more limitations due to physical (difference 12.5 points, P = .008) and emotional (13.3 points, P = .002) health problems compared with controls. Patients also had an increased risk to suffer from anxiety (odds ratio [OR]: 2.6, 95% CI: 1.2-5.7) and depression (OR: 3.7, 95% CI: 1.3-10.5). Neurocognitive deficits were found in 43% of patients. Although postoperative complications, radiotherapy, and reresection were associated with worse verbal memory, attention, and executive functioning when compared to patients resected once, the only clinically relevant association was between reresection and worse attention (–2.11, 95% CI: –3.52 to –0.07). Patients of working age less often had a paid job (48%) compared with the working-age Dutch population (72%) and reported more obstacles at work compared with controls. CONCLUSION In the long term, a large proportion of meningioma patients have impaired HRQoL, neurocognitive deficits, and high levels of anxiety or depression. Patients treated with 1 resection have the best neurocognitive functioning.

中文翻译:

颅内脑膜瘤患者手术和放疗后的长期疾病负担和生存问题

摘要 背景 许多颅内脑膜瘤患者在干预后长达 4 年的健康相关生活质量 (HRQoL) 和神经认知功能受损。目的 评估脑膜瘤患者的长期(≥5 年)疾病负担。方法 在这项多中心横断面研究中,干预(包括主动磁共振成像 (MRI) 监测)后≥5 年的患者被纳入并评估 HRQoL(简式健康调查 36)、神经认知功能(神经心理学评估)、焦虑和抑郁症(医院焦虑和抑郁量表)和工作效率(简式健康和劳动问卷)。多变量和倾向评分回归分析用于比较患者和对照组,并针对可能的混杂因素校正不同的治疗策略。报告了临床相关的差异。结果 在干预后中位 9 年的随访中,脑膜瘤患者 (n = 190) 报告由于身体(差异 12.5 分,P = .008)和情绪(13.3 分,P = .002)健康问题而受到的限制更多带控件。患者患焦虑症(比值比 [OR]:2.6,95% CI:1.2-5.7)和抑郁(OR:3.7,95% CI:1.3-10.5)的风险也增加。43% 的患者存在神经认知缺陷。尽管与仅切除一次的患者相比,术后并发症、放疗和再切除与更差的语言记忆、注意力和执行功能相关,但唯一具有临床相关性的关联是再次切除和更差的注意力(–2.11,95% CI:–3.52 至 – 0.07)。与荷兰工作年龄人群 (72%) 相比,工作年龄患者从事有偿工作的频率较低 (48%),并且与对照组相比,他们报告的工作障碍更多。结论从长远来看,很大一部分脑膜瘤患者存在 HRQoL 受损、神经认知缺陷以及高度焦虑或抑郁。接受 1 次切除治疗的患者具有最佳的神经认知功能。
更新日期:2020-08-20
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