Kerkmann Anna, Schinke Christian, Dordevic Adam, Kern Johannes, Bangemann Nikola, Finck Josefine, Blohmer Jens-Uwe, Ruprecht Klemens, Göpfert Jens C, Otto Carolin, Materne Bianca, Endres Matthias, Boehmerle Wolfgang, Huehnchen Petra
Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Klinik für Neurologie mit Experimenteller Neurologie, 10117 Berlin, Germany.
Berlin Institute of Health, Charité-Universitätsmedizin Berlin, 10178 Berlin, Germany.
Oncologist. 2025 Feb 6;30(2). doi: 10.1093/oncolo/oyae268.
Chemotherapy-induced cognitive impairment (CICI) is a well-recognized side effect of breast cancer treatment. However, prospective long-term evaluations of CICI using standardized neuropsychological tests are scarce.
This prospective longitudinal cohort study investigated cognitive dysfunction and its impact on quality of life and everyday functioning in patients with breast cancer receiving first-line chemotherapy compared to patients with breast cancer without chemotherapy. Assessment occurred prior to chemotherapy, postchemotherapy (median 6 months), and 2-3 years later. We used standardized neuropsychological tests, questionnaires, and scales to assess patients' quality of life and functioning. Additionally, serum analysis for neurodegenerative markers and autoantibodies was conducted.
We included n = 53 patients. Overall cognitive function declined statistically significantly (P = .046) postchemotherapy compared to control patients, mostly driven by a reduced figural memory (P = .011). Patients who received chemotherapy showed a greater reduction in quality of life (increased fatigue symptoms, P = .023; reduced Karnofsky index, P < .001); however, without a statistically significant effect on cognitive decline. The neurodegenerative markers Neurofilament light chain (NfL) and phosphorylated Neurofilament heavy chain (pNfH) increased statistically significantly (P < .001) postchemotherapy and pNfH correlated with overall cognitive function. After 2-3 years, both cognitive performance and quality of life were comparable between chemotherapy-treated and control patients.
Our findings suggest that chemotherapy statistically significantly contributes to overall cognitive dysfunction in patients with breast cancer, which disappears after 2-3 years, indicating a recovery in both objectively measurable cognitive function and subjective quality of life. Future research should examine larger sample sizes and explore screening indicators, particularly pNfH.
化疗引起的认知障碍（CICI）是乳腺癌治疗中一种公认的副作用。然而，使用标准化神经心理学测试对CICI进行前瞻性长期评估的研究较少。
这项前瞻性纵向队列研究调查了接受一线化疗的乳腺癌患者与未接受化疗的乳腺癌患者相比的认知功能障碍及其对生活质量和日常功能的影响。在化疗前、化疗后（中位数6个月）以及2至3年后进行评估。我们使用标准化神经心理学测试、问卷和量表来评估患者的生活质量和功能。此外，还进行了神经退行性标志物和自身抗体的血清分析。
我们纳入了n = 53例患者。与对照患者相比，化疗后总体认知功能有统计学显著下降（P = 0.046），主要是由图形记忆减退所致（P = 0.011）。接受化疗的患者生活质量下降更明显（疲劳症状增加，P = 0.023；卡诺夫斯基指数降低，P < 0.001）；然而，对认知衰退没有统计学显著影响。化疗后神经退行性标志物神经丝轻链（NfL）和磷酸化神经丝重链（pNfH）有统计学显著升高（P < 0.001），且pNfH与总体认知功能相关。2至3年后，化疗组和对照组患者的认知表现和生活质量相当。
我们的研究结果表明，化疗对乳腺癌患者的总体认知功能障碍有统计学显著影响，这种影响在2至3年后消失，表明客观可测量的认知功能和主观生活质量均有所恢复。未来的研究应检查更大的样本量并探索筛查指标，特别是pNfH。
