Purpose:Cognitive decline is a major concern for nasopharyngeal carcinoma (NPC) survivors after radiotherapy (RT). We assessed whether the rates of cognitive decline in NPC survivors differed depending on the presence of epilepsy.Methods:Based on an ongoing prospective cohort study (NCT03908502), we included consecutive NPC patients with a history of radiotherapy who underwent a baseline and follow-up cognition assessment between January 2005 and December 2023. Patients who had a confirmed diagnosis of epilepsy before radiotherapy, had intracranial brain metastasis during follow-up, lacked baseline major clinical data, or lacked follow-up cognitive assessment of longer than six months were excluded. The outcome was cognitive function assessed by the Chinese version of the Montreal Cognitive Assessment (MoCA), with assessments being performed every 6 months through face-to-face interviews. Linear mixed-effect models were used to analyze the progression rate of MoCA scores by epilepsy status (incident, prevalent, or no epilepsy).Results:A total of 521 patients with a median follow-up period of 3.96 years were included in our study. The rate of decline in MoCA was significantly faster in patients with prevalent epilepsy compared with no epilepsy after adjusting for demographics, health behaviors, tumor-related history, complications, anti-seizure medication, and inflammatory blood index (estimate: −1.407; 95%CI: −2.419, −0.412;p= 0.007). However, the cognitive decline rate was similar in the incident epilepsy group compared with that in the non-epilepsy group (p= 0.126). Subgroup analysis showed that there was no significant difference in the effect of epilepsy status on cognitive deterioration among subgroups stratified by the pre-planned covariates.Conclusions:Global cognitive function declined more rapidly in NPC patients with prevalent epilepsy. The control of seizure attacks may be valuable to mitigate cognitive decline.
目的：认知功能下降是鼻咽癌放疗后幸存者的主要关注问题。本研究旨在评估鼻咽癌幸存者的认知功能下降速率是否因癫痫病史的存在而存在差异。方法：基于一项正在进行的前瞻性队列研究（NCT03908502），我们连续纳入了2005年1月至2023年12月期间接受过放疗并完成基线及随访认知评估的鼻咽癌患者。排除标准包括：放疗前确诊癫痫、随访期间出现颅内脑转移、缺乏基线主要临床数据或缺乏超过六个月的随访认知评估。主要结局指标为采用中文版蒙特利尔认知评估量表评估的认知功能，通过面对面访谈每6个月进行一次评估。采用线性混合效应模型分析不同癫痫状态（新发癫痫、既存癫痫或无癫痫）患者的MoCA评分进展速率。结果：本研究共纳入521例患者，中位随访时间为3.96年。在校正人口统计学特征、健康行为、肿瘤相关病史、并发症、抗癫痫药物及炎症血液指标后，既存癫痫患者的MoCA评分下降速率显著快于无癫痫患者（估计值：-1.407；95%置信区间：-2.419至-0.412；p=0.007）。然而，新发癫痫组与无癫痫组的认知下降速率无显著差异（p=0.126）。亚组分析显示，按预设协变量分层的各亚组中，癫痫状态对认知功能恶化的影响均无显著差异。结论：伴有既存癫痫的鼻咽癌患者整体认知功能下降更为迅速。控制癫痫发作可能对延缓认知功能下降具有重要价值。
肿瘤(癌症)患者之家