Mandelblatt Jeanne S, Stern Robert A, Luta Gheorghe, McGuckin Meghan, Clapp Jonathan D, Hurria Arti, Jacobsen Paul B, Faul Leigh Anne, Isaacs Claudine, Denduluri Neelima, Gavett Brandon, Traina Tiffany A, Johnson Patricia, Silliman Rebecca A, Turner R Scott, Howard Darlene, Van Meter John W, Saykin Andrew, Ahles Tim
Jeanne S. Mandelblatt, Gheorghe Luta, Meghan McGuckin, Jonathan D. Clapp, Leigh Anne Faul, Claudine Isaacs, Neelima Denduluri, R. Scott Turner, Darlene Howard, and John W. Van Meter, Georgetown University, Washington, DC; Robert A. Stern, Brandon Gavett, Patricia Johnson, and Rebecca A. Silliman, Boston University School of Medicine, Boston, MA; Arti Hurria, City of Hope Comprehensive Cancer Center, Duarte, CA; Paul B. Jacobsen, Moffitt Cancer Center; Patricia Johnson, University of South Florida, Tampa, FL; Neelima Denduluri, Virginia Cancer Specialists, Arlington, VA; Tiffany A. Traina and Tim Ahles, Memorial Sloan-Kettering Cancer Center; Tiffany A. Traina, Weill Medical College of Cornell University, New York, NY; and Andrew Saykin, Indiana University School of Medicine, Indianapolis, IN.
J Clin Oncol. 2014 Jun 20;32(18):1909-18. doi: 10.1200/JCO.2013.54.2050. Epub 2014 May 19.
To determine if older patients with breast cancer have cognitive impairment before systemic therapy.
Participants were patients with newly diagnosed nonmetastatic breast cancer and matched friend or community controls age > 60 years without prior systemic treatment, dementia, or neurologic disease. Participants completed surveys and a 55-minute battery of 17 neuropsychological tests. Biospecimens were obtained for APOE genotyping, and clinical data were abstracted. Neuropsychological test scores were standardized using control means and standard deviations (SDs) and grouped into five domain z scores. Cognitive impairment was defined as any domain z score two SDs below or ≥ two z scores 1.5 SDs below the control mean. Multivariable analyses evaluated pretreatment differences considering age, race, education, and site; comparisons between patient cases also controlled for surgery.
The 164 patient cases and 182 controls had similar neuropsychological domain scores. However, among patient cases, those with stage II to III cancers had lower executive function compared with those with stage 0 to I disease, after adjustment (P = .05). The odds of impairment were significantly higher among older, nonwhite, less educated women and those with greater comorbidity, after adjustment. Patient case or control status, anxiety, depression, fatigue, and surgery were not associated with impairment. However, there was an interaction between comorbidity and patient case or control status; comorbidity was strongly associated with impairment among patient cases (adjusted odds ratio, 8.77; 95% CI, 2.06 to 37.4; P = .003) but not among controls (P = .97). Only diabetes and cardiovascular disease were associated with impairment among patient cases.
There were no overall differences between patients with breast cancer and controls before systemic treatment, but there may be pretreatment cognitive impairment within subgroups of patient cases with greater tumor or comorbidity burden.
确定老年乳腺癌患者在全身治疗前是否存在认知障碍。
参与者为新诊断的非转移性乳腺癌患者以及年龄>60岁、未接受过全身治疗、无痴呆或神经疾病的匹配朋友或社区对照者。参与者完成调查问卷以及一组为期55分钟的包含17项神经心理学测试。获取生物标本进行载脂蛋白E（APOE）基因分型，并提取临床数据。神经心理学测试分数使用对照均值和标准差（SD）进行标准化，并分组为五个领域的z分数。认知障碍定义为任何领域的z分数低于对照均值两个标准差或≥两个z分数低于对照均值1.5个标准差。多变量分析评估了考虑年龄、种族、教育程度和部位的治疗前差异；患者病例之间的比较也对手术进行了控制。
164例患者病例和182例对照者的神经心理学领域分数相似。然而，在患者病例中，调整后，II至III期癌症患者的执行功能低于0至I期疾病患者（P = 0.05）。调整后，年龄较大、非白人、受教育程度较低的女性以及合并症较多的女性出现认知障碍的几率显著更高。患者病例或对照状态、焦虑、抑郁、疲劳和手术与认知障碍无关。然而，合并症与患者病例或对照状态之间存在相互作用；合并症在患者病例中与认知障碍密切相关（调整后的优势比，8.77；95%可信区间，2.06至37.4；P = 0.003），但在对照者中则不然（P = 0.97）。在患者病例中，只有糖尿病和心血管疾病与认知障碍有关。
在全身治疗前，乳腺癌患者与对照者之间总体上没有差异，但在肿瘤或合并症负担较重的患者病例亚组中可能存在治疗前认知障碍。
