乳腺癌病人新辅助化疗后脑白质高信号体积的早期变化

Early changes in white matter hyperintensities volume after neoadjuvant chemotherapy in breast cancer patients

目的旨在探索乳腺癌病人在新辅助化疗(NAC)1个周期后,脑白质高信号(WMH)体积的纵向变化。方法前瞻性纳入51例拟行NAC治疗的女性乳腺癌病人(NAC组),平均年龄(48.73±9.02)岁;同时纳入50名女性健康对照(HC组),平均年龄(49.66±11.53)岁。NAC组病人分别于基线时和化疗第1周期后接受颅脑MRI扫描和神经心理学测试,并根据其年龄分为低龄组(<49岁)和高龄组(≥49岁)。HC组于基线时接受一次与乳腺癌病人相同的评估。根据WMH与侧脑室的距离,将其分为侧脑室缘WMH、侧脑室旁WMH、深部WMH和近皮质WMH。采用Mann-Whitney U检验比较基线时2组间WMH体积及神经心理学测试评分;采用Wilcoxon符号秩检验比较NAC组病人、高龄组病人及低龄组病人化疗前后WMH体积及神经心理学测试评分的纵向变化。对于NAC组病人化疗前后WMH体积差异有统计学意义的脑区,采用Spearman相关分析WMH体积差异与神经心理学测试评分差异之间的相关性。结果NAC组和HC组的基线WMH体积和神经心理学测试评分差异均无统计学意义(均P>0.05)。NAC组病人化疗后FACT-Cog、PCA、PCI评分均较基线减低(均P<0.05)。所有NAC病人和高龄组化疗后侧脑室缘WMH、侧脑室旁WMH、深部WMH和总WMH体积均较基线增加(均P<0.05),低龄组化疗后各脑区WMH体积与基线相比差异均无统计学意义(均P>0.05)。NAC组病人化疗后侧脑室旁WMH体积变化与执行功能评估中的连线测试A部分(TMT-A)耗时的变化呈显著正相关(ρ=0.446,P=0.001)。结论乳腺癌病人化疗后侧脑室缘WMH、侧脑室旁WMH、深部WMH和总WMH体积均较基线时增加,侧脑室旁WMH体积的增加与执行功能的下降有关。化疗对年龄大于49岁的病人WMH体积的影响更大。

Objective To explore the longitudinal changes in white matter hyperintensities(WMH)volume after one cycle of neoadjuvant chemotherapy(NAC)in breast cancer patients.Method A total of 51 female breast cancer patients(NAC group)with an average age of(48.73±9.02)years old who planned to receive NAC were enrolled prospectively.At the same time,50 female healthy controls(HC group)were included,with an average age of(49.66±11.53)years old.Patients in the NAC group received brain MR scans and neuropsychological tests at baseline and after the first cycle of chemotherapy.They were divided into younger group(<49 years old)and older group(≥49 years old)based their age.The HC group received the same assessment as the breast cancer patients at baseline.According to the distance between WMH and lateral ventricle,WMH was divided into juxtaventricular WMH,periventricular WMH,deep WMH,and juxtacortical WMH.The comparison of WMH volume and neuropsychological test scores between the two groups at baseline was performed using the Mann-Whitney U test.The Wilcoxon signed-rank test was used to compare the longitudinal changes in WMH volume and neuropsychological tests scores before and after chemotherapy in the NAC group,older group,and younger group.For the brain regions with statistically significant differences in WMH volume before and after chemotherapy in the NAC group,Spearman correlation analysis was used to analyze the correlation between changes in WMH volume and changes in neuropsychological tests scores.Results There was no significant difference in WMH volume and neuropsychological tests scores between NAC group and HC group at baseline(all P>0.05).After chemotherapy,the FACT-Cog,PCA,and PCI scores in the NAC group were lower than those at baseline(all P<0.05).The volume of juxtaventricular WMH,periventricular WMH,deep WMH,and total WMH in all NAC patients and older group after chemotherapy increased compared with baseline(all P<0.05).In the younger group,there was no significant difference in the volume of WMH in each brain region after chemotherapy compared with baseline(all P>0.05).In the NAC group,the change in the volume of periventricular WMH after chemotherapy was positively correlated with the change in time taken for the Trail Making Test Part A(TMT-A)(ρ=0.446,P=0.001).Conclusions The volume of juxtaventricular WMH,periventricular WMH,deep WMH,and total WMH volume increase significantly in breast cancer patients after chemotherapy.The increase in periventricular WMH volume may be related to a decrease in executive function.Additionally,chemotherapy has a greater effect on the volume of WMH in patients over 49 years old.