新辅助化疗不同周期后乳腺癌患者脑功能网络的改变

Altered Brain Functional Networks in Patients With Breast Cancer After Different Cycles of Neoadjuvant Chemotherapy.

作者信息

Yang Jing, Deng Yongchun, Liu Daihong, Hu Yixin, Tang Yu, Zhou Xiaoyu, Tan Yong, Zhang Jing, Liu Jiang, Wang Chengfang, Zeng Xiaohua, Zhang Jiuquan

机构信息

Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China.

Department of Breast Cancer Center, Chongqing University Cancer Hospital, School of Medicine, Chongqing, China.

出版信息

J Magn Reson Imaging. 2025 Sep;62(3):902-914. doi: 10.1002/jmri.29772. Epub 2025 Apr 9.

DOI:10.1002/jmri.29772

PMID:40200727

Abstract

BACKGROUND

Cancer-related cognitive impairment (CRCI) impacts breast cancer (BC) patients' quality of life after chemotherapy. While recent studies have explored its neural correlates, single time-point designs cannot capture how these changes evolve over time.

PURPOSE

To investigate changes in the brain connectome of BC patients at several time points during neoadjuvant chemotherapy (NAC).

STUDY TYPE

Longitudinal.

SUBJECTS

55 participants with BC underwent clinical assessments and fMRI at baseline (TP1), the first cycle of NAC (TP2, 30 days later), and the end (TP3, 140 days later). Two matched female healthy control (HCs, n = 20 and n = 18) groups received the same assessments. FIELD STRENGTH/SEQUENCE: rs-fMRI (gradient-echo EPI) and 3D T1-weighted magnetization-prepared rapid gradient echo sequence at 3.0 T.

ASSESSMENT

Brain functional networks were analyzed using graph theory approaches. We analyzed changes in brain connectome metrics and explored the relationship between these changes and clinical scales (including emotion and cognitive test). Patients were divided into subgroups according to clinical classification, chemotherapy regimen, and menopausal status. Longitudinal analysis was performed at three time points for each subgroup.

STATISTICAL TESTS

An independent sample t-test for patient-HC comparison at TP1. Analysis of variance and paired t-test for longitudinal changes. Regression analysis for relations between network measurements changes and clinical symptom scores changes. Significance was defined as p < 0.05.

RESULTS

Post-NAC, BC patients showed increased global efficiency (TP2-TP1 = 0.087, TP3-TP1 = 0.078), decreased characteristic path length (TP2-TP1 = -0.413, TP3-TP1 = -0.312), and altered nodal centralities mainly in the frontal-limbic system and cerebellar cortex. These abnormalities expanded with chemotherapy progression significantly (TP2 vs. TP3). Topological parameters changes were also correlated with clinical scales changes significantly. No differences were found within or between HC groups (p = 0.490-0.989) or BC subgroups (p = 0.053-0.988) at TP1.

DATA CONCLUSIONS

NAC affects the brain functional connectome of BC patients at TP2, and these changes persist and further intensify at TP3.

TECHNICAL EFFICACY

Stage 5.

摘要

背景

癌症相关认知障碍（CRCI）会影响乳腺癌（BC）患者化疗后的生活质量。虽然最近的研究已经探讨了其神经相关性，但单一时间点设计无法捕捉这些变化如何随时间演变。

目的

研究新辅助化疗（NAC）期间多个时间点BC患者脑连接组的变化。

研究类型

纵向研究。

研究对象

55名BC患者在基线（TP1）、NAC的第一个周期（TP2，30天后）和结束时（TP3，140天后）接受了临床评估和功能磁共振成像（fMRI）。两个匹配的女性健康对照组（HCs，n = 20和n = 18）接受了相同的评估。场强/序列：3.0 T时的静息态功能磁共振成像（rs-fMRI，梯度回波EPI）和三维T1加权磁化准备快速梯度回波序列。

评估

使用图论方法分析脑功能网络。我们分析了脑连接组指标的变化，并探讨了这些变化与临床量表（包括情绪和认知测试）之间的关系。根据临床分类、化疗方案和绝经状态将患者分为亚组。对每个亚组在三个时间点进行纵向分析。

统计检验

在TP1时对患者与HC进行独立样本t检验。对纵向变化进行方差分析和配对t检验。对网络测量变化与临床症状评分变化之间的关系进行回归分析。显著性定义为p < 0.05。

结果

NAC后，BC患者的全局效率增加（TP2 - TP1 = 0.087，TP3 - TP1 = 0.078），特征路径长度缩短（TP2 - TP1 = -0.413，TP3 - TP1 = -0.312），并且主要在额叶 - 边缘系统和小脑皮质的节点中心性发生改变。这些异常随着化疗进展而显著扩大（TP2与TP3相比）。拓扑参数变化也与临床量表变化显著相关。在TP1时，HC组内或组间（p = 0.490 - 0.989）或BC亚组间（p = 0.053 - 0.988）未发现差异。