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The
predictive value of longitudinal neuropsychologic assessment in the
early detection of brain tumor recurrence
Armstrong
CL, Goldstein B, Shera D, Ledakis GE, Tallent EM
Department
of Neurology, University of Pennsylvania Medical School, Philadelphia,
Pennsylvania
Background.
Neuropsychologic tests are widely used to predict the course of
progressive neurologic diseases, and recent research has demonstrated
the specificity of cognitive measures, even in relatively diffuse
diseases.
However, the cognitive effects of brain tumors of similar histology
and location are known to be highly variable.
The authors used the specificity of cognitive function principle to
compare two models for the early detection of low-grade brain tumor
recurrence prior to detection with clinically scheduled neuroimaging.
Methods.
To test the feasibility of these prediction models, 34 patients with
supratentorial, low-grade brain tumors prospectively were administered
serial comprehensive neuropsychologic examinations; 11 patients
developed recurrent tumors during the series and 23 patients did not.
A general model based on tests sensitive to malignancy and white
matter disease was compared with a tumor-specific model based on
indices related to each patient's tumor locus.
A Cox proportional hazards model was used to identify the predictor
variables that significantly changed immediately prior to recurrence.
Results.
Only the tumor-specific model achieved statistical significance (P
< 0.02).
A tumor-specific index decline of 1 standard deviation indicated a
5-fold increase in the probability of tumor recurrence.
Conclusions.
Although this method needs to be tested with more frequent and regular
observations and with a larger sample, these results provide evidence
of the feasibility of the subject-specific model as a predictor of
recurrence.
The evidence of the predictive value of a tumor-specific model is
consistent with studies that identify only limited, brain
structure-specific cognitive decline from broad neuropsychologic
batteries.
Copyright 2003 American Cancer Society
PMID: 12548607 [PubMed - in process]
Source:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12548607&dopt=Abstract
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