Cognitive Impairment in Long-Term Survivors of Testicular Cancer More Than 20 Years after Treatment

Autor:	Annemiek M E Walenkamp, Janine Nuver, Sanne B. Schagen, Sandra E. Rakers, Rients Huitema, Andrea T Meuleman, Jan W Donkerbroek, Lara M. Kruyt, Erwin M. Wiegman, Jourik A. Gietema, Johannes Stelwagen, Marianne A A de Jong, Gerrie Steursma, Coby Meijer, Alfons C.M. van den Bergh, Igle J. de Jong, Joop D. Lefrandt, Joost A Agelink van Rentergem, Sjoukje Lubberts
Přispěvatelé:	FMG, Brein en Cognitie (Psychologie, FMG), Psychology Other Research (FMG), Guided Treatment in Optimal Selected Cancer Patients (GUTS), Damage and Repair in Cancer Development and Cancer Treatment (DARE)
Jazyk:	angličtina
Rok vydání:	2021
Předmět:	Cancer Research medicine.medical_specialty Univariate analysis business.industry Trail Making Test Late effect Neoplasms. Tumors. Oncology. Including cancer and carcinogens medicine.disease Verbal learning Article Cognitive test testicular cancer Oncology Internal medicine medicine neurocognitive impairment cancer survivors Orchiectomy medicine.symptom business late toxicity Testicular cancer RC254-282 Cohort study
Zdroj:	Cancers, 13(22):5675. Multidisciplinary Digital Publishing Institute (MDPI) Cancers, 13(22):5675. MDPI AG Cancers, Vol 13, Iss 5675, p 5675 (2021) Cancers Volume 13 Issue 22
ISSN:	2072-6694
Popis:	Background: Impaired cognition can be a late effect after treatment in long-term testicular cancer (TC) survivors, negatively affecting their daily life. However, little data is available beyond 20 years post-treatment. We assessed cognitive impairment in very long-term TC survivors after CT or RT and compared the results with stage I TC survivors and controls. Methods: In this cross-sectional multicenter cohort study, we enrolled TC survivors (treated with orchiectomy followed by CT or RT or orchiectomy only)—with a follow-up duration ≥ 20 years—and age-matched healthy controls. Cognitive testing included the Auditory Verbal Learning Test, Letter Fluency Test, Category Fluency Test, and Trail Making Test. We used fasting blood samples to assess the presence of hypogonadism and measured cardiovascular aging parameters, including carotid pulse wave velocity (c-PWV) and advanced glycation end products (AGEs). Results: We included 184 TC survivors (66 CT patients, 53 RT patients, and 65 orchiectomy-only patients) and 70 healthy controls. The median follow-up was 26 years (range: 20–42). TC survivors had a lower combined score of the cognitive tests (mean cumulative Z-score −0.85 95% CI −1.39 to −0.33) compared to controls (mean 0.67 95% CI −0.21 to 1.57, p < 0.01). In univariate analysis, the presence of hypogonadism (β −1.50, p < 0.01), high c-PWV (β −0.35, p = 0.09), and high AGEs (β −1.27, p = 0.02) were associated with lower cognitive scores, while only AGEs (β −1.17, p = 0.03) remained a significant predictor in multivariate analysis (Model R2 0.31, p < 0.01). Conclusions: Long-term TC survivors performed worse on cognitive tests compared to controls. Physicians and patients should be informed about timely cardiovascular risk management and testosterone supplementation therapy during follow-up to reduce the risk of cognitive impairment. Trial Registration: NCT02572934.
Databáze:	OpenAIRE
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