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J Clin Oncol:乳腺癌化疗后大脑认知功能减退的罪魁祸首

2021-10-31 MedSci原创 MedSci原创

化疗脑:20%~40%的乳腺癌患者化疗后可出现记忆力、注意力、思维等大脑认知功能减退,可能持续至康复期并干扰日常生活技能和生活质量。在化疗前预测化疗后有脑功能减退风险的乳腺癌患者,将有助于改善患者治疗

化疗脑:20%~40%的乳腺癌患者化疗后可出现记忆力、注意力、思维等大脑认知功能减退,可能持续至康复期并干扰日常生活技能和生活质量。在化疗前预测化疗后有脑功能减退风险的乳腺癌患者,将有助于改善患者治疗。

2021年9月30日,J Clin Oncol.杂志在线发表荷兰国家癌症研究所、阿姆斯特丹大学的研究报告,探讨了乳腺癌化疗后大脑认知功能减退的风险因素和预测方法。

筛选流程

de Ruiter MB等开展了病例对照研究,对乳腺癌患者接受蒽环类化疗前(52例)和化疗后6个月(49例)、2年(32例)和3年(32例)进行神经心理问卷评分和磁共振检查,以匹配的时间间隔对乳腺癌未化疗患者(39例、39例、23例、19例)和无癌症对照者(44例、37例、29例、28例)进行神经心理问卷评分和脑磁共振检查。

通过多因素规范化比较,对患者组与对照组的认知特征偏差程度进行分析。根据磁共振弥散张量成像的各向异性分数,对治疗前的脑白质微观结构进行定量分析。除了基线年龄、疲劳、认知主诉和病前智商之外,各向异性分数被评价为认知能力下降的风险因素。随后,进行体素弥散张量成像分析,分析特定神经束的脑白质微观结构。

de Ruiter MB等发现各向异性分数FA可独立预测乳腺癌患者化疗后早期(6个月,P=0.013)和晚期(3年,P<0.001)认知能力减退,与年龄、病前智商、基线疲劳和基线认知主诉无关,而且不能预测乳腺癌未化疗患者和无癌症对照者的认知能力减退。

体素分析表明,脑白质束对认知功能至关重要。

基线FA与3次随访认知减退相关关系散点图

乳腺癌化疗前脑FA可能反映脑白质储备,可能是乳腺癌化疗后认知能力减退的风险因素。对脑白质储备较低的患者进行化疗前筛查,将有助于改善患者预后。

原文出处

de Ruiter MB, Reneman L, Kieffer JM, Oldenburg HSA, Schagen SB. Brain White Matter Microstructure as a Risk Factor for Cognitive Decline After Chemotherapy for Breast Cancer. J Clin Oncol. 2021 Sep 30:JCO2100627. doi: 10.1200/JCO.21.00627. Epub ahead of print. PMID: 34591652.

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    2021-12-25 minlingfeng
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    2021-11-01 ms3000000904619767

    学习

    0

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    2021-11-01 ms7000001095085973

    学习

    0

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    2021-10-31 JZ Yang

    有意思呢

    0

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