Ferdousi Maryam, Azmi Shazli, Petropoulos Ioannis Nikolaos, Fadavi Hassan, Ponirakis Georgios, Marshall Andrew, Tavakoli Mitra, Malik Imaan, Mansoor Wasat, Malik Rayaz Ahmed
Institute of Human Development, Centre for Endocrinology & Diabetes, Faculty of Medical and Human Sciences, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester, United Kingdom.
Institute of Human Development, Centre for Endocrinology & Diabetes, Faculty of Medical and Human Sciences, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester, United Kingdom; Weill Cornell Medical College Qatar, Division of Research, Qatar Foundation, Education City, Doha, Qatar.
PLoS One. 2015 Oct 2;10(10):e0139394. doi: 10.1371/journal.pone.0139394. eCollection 2015.
There are multiple neurological complications of cancer and its treatment. This study assessed the utility of the novel non-invasive ophthalmic technique of corneal confocal microscopy in identifying neuropathy in patients with upper gastrointestinal cancer before and after platinum based chemotherapy. In this study, 21 subjects with upper gastrointestinal (oesophageal or gastric) cancer and 21 healthy control subjects underwent assessment of neuropathy using the neuropathy disability score, quantitative sensory testing for vibration perception threshold, warm and cold sensation thresholds, cold and heat induced pain thresholds, nerve conduction studies and corneal confocal microscopy. Patients with gastro-oesophageal cancer had higher heat induced pain (P = 0.04) and warm sensation (P = 0.03) thresholds with a significantly reduced sural sensory (P<0.01) and peroneal motor (P<0.01) nerve conduction velocity, corneal nerve fibre density (CNFD), nerve branch density (CNBD) and nerve fibre length (CNFL) (P<0.0001). Furthermore, CNFD correlated significantly with the time from presentation with symptoms to commencing chemotherapy (r = -0.54, P = 0.02), and CNFL (r = -0.8, P<0.0001) and CNBD (r = 0.63, P = 0.003) were related to the severity of lymph node involvement. After the 3rd cycle of chemotherapy, there was no change in any measure of neuropathy, except for a significant increase in CNFL (P = 0.003). Corneal confocal microscopy detects a small fibre neuropathy in this cohort of patients with upper gastrointestinal cancer, which was related to disease severity. Furthermore, the increase in CNFL after the chemotherapy may indicate nerve regeneration.
癌症及其治疗存在多种神经并发症。本研究评估了新型非侵入性眼科技术——角膜共焦显微镜在识别接受铂类化疗前后的上消化道癌患者神经病变方面的效用。在本研究中，21名上消化道（食管或胃）癌患者和21名健康对照者接受了神经病变评估，采用神经病变残疾评分、振动感觉阈值、冷热感觉阈值、冷热诱发疼痛阈值的定量感觉测试、神经传导研究和角膜共焦显微镜检查。胃食管癌患者的热诱发疼痛（P = 0.04）和温觉（P = 0.03）阈值较高，腓肠感觉神经（P<0.01）和腓总运动神经（P<0.01）传导速度、角膜神经纤维密度（CNFD）、神经分支密度（CNBD）和神经纤维长度（CNFL）显著降低（P<0.0001）。此外，CNFD与出现症状至开始化疗的时间显著相关（r = -0.54，P = 0.02），CNFL（r = -0.8，P<0.0001）和CNBD（r = 0.63，P = 0.003）与淋巴结受累的严重程度相关。化疗第3周期后，除CNFL显著增加（P = 0.003）外，神经病变的任何测量指标均无变化。角膜共焦显微镜在该组上消化道癌患者中检测到小纤维神经病变，这与疾病严重程度相关。此外，化疗后CNFL的增加可能表明神经再生。
