Background: IDH1-mutant oligodendroglioma and astrocytoma differ not only in growth rate but also in growth pattern. Oligodendrogliomas tend to infiltrate white matter tracts, whereas astrocytomas more often displace them. Such difference could lead to different cognitive outcomes. This study examined differences in executive functioning before and up to one year after surgery between patients with IDH1-mutant astrocytoma and oligodendroglioma. Methods: Patients with WHO grade 2–3 IDH1-mutant oligodendroglioma (1p19q-codeleted) or astrocytoma were included. Cognition was assessed preoperatively, and at 3 and 12 months postoperatively using standardized computerized and paper-and-pencil tests. Groups were compared on demographics, tumor characteristics, surgical modality, extent of resection, adjuvant treatment, and baseline cognition. Longitudinal mixed models were performed to investigate differences in performances over time for the total sample and stratified by surgical approach (awake vs. asleep). Results: 162 patients (67 oligodendroglioma, 95 astrocytoma) were included. Oligodendroglioma patients were older, with more frontal and fewer temporal tumors. Oligodendroglioma patients showed a greater impairment prevalence on a measure of inhibition before surgery. In the awake surgery group, no longitudinal differences were found between diagnoses. In the asleep surgery group, astrocytoma patients remained stable while oligodendroglioma patients declined on a measure of cognitive flexibility, with performance at 3 and 12 months significantly lower than at baseline. Conclusions: Specific aspects of executive functioning in IDH1-mutant gliomas may differ by subtype. Oligodendroglioma patients showed postoperative decline in cognitive flexibility that did not recover to baseline level, particularly in case of surgery under general anesthesia. These results highlight the potential relevance of tumor subtype and surgical approach in limiting cognitive risks after glioma surgery.
背景：IDH1突变型少突胶质细胞瘤和星形细胞瘤不仅在生长速度上存在差异，其生长模式亦有所不同。少突胶质细胞瘤倾向于浸润白质纤维束，而星形细胞瘤则更常推移这些结构。这种差异可能导致不同的认知结果。本研究探讨了IDH1突变型星形细胞瘤与少突胶质细胞瘤患者在手术前及术后一年内执行功能的差异。 方法：研究纳入WHO 2-3级IDH1突变型少突胶质细胞瘤（伴1p19q共缺失）或星形细胞瘤患者。通过标准化计算机测试和纸笔测试，在术前、术后3个月和12个月进行认知评估。比较两组患者的人口统计学特征、肿瘤特征、手术方式、切除范围、辅助治疗及基线认知水平。采用纵向混合模型分析总体样本及按手术方式（清醒手术 vs 全身麻醉手术）分层后认知表现随时间变化的差异。 结果：共纳入162例患者（67例少突胶质细胞瘤，95例星形细胞瘤）。少突胶质细胞瘤患者年龄更大，额叶肿瘤更多而颞叶肿瘤更少。术前评估显示少突胶质细胞瘤患者在抑制功能指标上表现出更高的损伤发生率。在清醒手术组中，不同诊断组间未发现纵向差异。在全身麻醉手术组中，星形细胞瘤患者保持稳定，而少突胶质细胞瘤患者在认知灵活性指标上出现下降，术后3个月和12个月的表现显著低于基线水平。 结论：IDH1突变型胶质瘤执行功能的特定方面可能因亚型而异。少突胶质细胞瘤患者术后出现认知灵活性下降且未恢复至基线水平，尤其在全身麻醉手术情况下更为明显。这些结果凸显了肿瘤亚型和手术方式在限制胶质瘤术后认知风险方面的潜在相关性。
肿瘤(癌症)患者之家