Department of Oncology, KU Leuven, Leuven, Belgium.
Department of Imaging & Pathology, KU Leuven, Leuven, Belgium.
Hum Brain Mapp. 2019 Dec 1;40(17):4994-5010. doi: 10.1002/hbm.24753. Epub 2019 Aug 21.
This study investigated volumetric brain changes and cognitive performance in premenopausal and postmenopausal patients treated for early-stage breast cancer. Participants underwent elaborate neurocognitive assessments (neuropsychological testing, cognitive failure questionnaire, and high-resolution T1-weighted structural MRI) before and after chemotherapy. Volumetric brain changes were estimated, using longitudinal deformation-based morphometry, and correlated with cognitive changes. In total, 180 women participated in this study, of whom 72 patients with breast cancer had received adjuvant chemotherapy (C+), 49 patients did not receive chemotherapy (C-), and 59 healthy controls (HC). The population was categorized into two age groups: A young group who were premenopausal and younger than 52 years at baseline (n = 55C+/32C-/41HC), and an older group who were postmenopausal and older than 60 years (n = 17C+/17C-/18HC). Cognitive impairment occurred after chemotherapy in both young and older patients, although older patients showed more decline in processing speed (Trail making test b). White matter volume expansion was observed after chemotherapy, only significantly present in the younger subgroup of patients. In patients not treated with chemotherapy, diffuse gray and white matter volume reduction was observed. Less white matter expansion concurred with more cognitive decline (r > .349, p < .05). In conclusion, we found age-dependent cognitive decline and white matter volume changes in patients with breast cancer after chemotherapy, which could possibly be linked to neuroinflammatory processes. White matter expansion after chemotherapy, more pronounced in premenopausal patients, correlated with less cognitive decline. This suggests such expansion to be age-dependent, possibly caused by a protective response in the younger brain to chemotherapy-induced neurotoxicity.
本研究调查了接受早期乳腺癌治疗的绝经前和绝经后患者的容积性脑变化和认知表现。参与者在化疗前后接受了详细的神经认知评估（神经心理学测试、认知失败问卷和高分辨率 T1 加权结构 MRI）。使用基于纵向变形的形态测量法估计了容积性脑变化，并将其与认知变化相关联。共有 180 名女性参与了这项研究，其中 72 名乳腺癌患者接受了辅助化疗（C+），49 名患者未接受化疗（C-），59 名健康对照者（HC）。该人群分为两个年龄组：一组是绝经前且基线时年龄小于 52 岁的年轻组（n=55C+/32C-/41HC），另一组是绝经后且年龄大于 60 岁的老年组（n=17C+/17C-/18HC）。尽管老年患者在处理速度（Trail making test b）方面表现出更大的下降，但年轻和老年患者在化疗后都出现了认知障碍。在接受化疗的患者中观察到白质体积膨胀，仅在年轻亚组患者中显著存在。在未接受化疗的患者中，观察到弥散性灰质和白质体积减少。较少的白质膨胀与更多的认知下降相关（r>.349，p<.05）。总之，我们发现接受化疗的乳腺癌患者存在年龄依赖性的认知下降和白质体积变化，这可能与神经炎症过程有关。化疗后白质膨胀更为明显，在绝经前患者中更为明显，与认知下降程度较低相关。这表明这种膨胀是年龄依赖性的，可能是年轻大脑对化疗引起的神经毒性的保护性反应所致。
