大脑灰质又称大脑皮质、大脑皮层，由各种神经元、神经胶质及大量出入皮质的神经纤维组成，色泽灰暗，是人类思维活动的物质基础、调节人体所有机能的最高中枢。大脑白质主要由神经纤维组成。
2018年8月7日，施普林格·自然旗下《乳腺癌研究与治疗》在线发表加利福尼亚希望之城国家医学中心、纽约纪念医院斯隆凯特林癌症中心、印第安纳大学医学院的研究报告，评估了乳腺癌老年患者辅助化疗前后大脑灰质密度的纵向变化。
该研究入组了16位I～III期乳腺癌接受辅助化疗的年龄≥60岁女性（平均年龄67岁）和15位年龄匹配的健康对照女性（平均年龄68.5岁）。化疗组在辅助化疗之前（时间点1）和化疗后1个月内（时间点2）接受脑磁共振检查和国家卫生研究院认知工具测试。健康对照组在对应时间点接受相同的评定。根据体素（体元）形态计量法对灰质密度进行评估。
结果发现，从时间点1到时间点2，化疗组的灰质密度显著降低。化疗组与健康对照组相比，从时间点1到时间点2，大脑左前扣带回、右岛叶、左中颞回的灰质密度显著降低（校正多重比较所致误差，P<0.05）。健康对照组入组时左岛叶灰质密度与入组时列表分类工作记忆评分成正比（校正多重比较所致误差，0.05）。不过，从时间点1到时间点2，认知测试评分变化与灰质密度变化无关（校正多重比较所致误差，P<0.05）。
因此，该研究结果表明，乳腺癌老年女性的灰质密度降低与辅助化疗相关。不过，有必要开展进一步研究了解神经影像检查结果的临床意义。
Breast Cancer Res Treat. 2018 Aug 7.
Gray matter density reduction associated with adjuvant chemotherapy in older women with breast cancer.
Bihong T. Chen, Taihao Jin, Sunita K. Patel, Ningrong Ye, Can-Lan Sun, Huiyan Ma, Russell C. Rockne, James C. Root, Andrew J. Saykin, Tim A. Ahles, Andrei I. Holodny, Neal Prakash, Joanne Mortimer, James Waisman, Yuan Yuan, Daneng Li, George Somlo, Jessica Vazquez, Abrahm Levi, Heidi Tan, Richard Yang, Vani Katheria, Arti Hurria.
City of Hope National Medical Center, Duarte, USA; Memorial Sloan-Kettering Cancer Center, New York, USA; Indiana University School of Medicine, Indianapolis, USA.
PURPOSE: The purpose of this study was to evaluate longitudinal changes in brain gray matter density (GMD) before and after adjuvant chemotherapy in older women with breast cancer.
METHODS: We recruited 16 women aged ≥60 years with stage I-III breast cancers receiving adjuvant chemotherapy (CT) and 15 age- and sex-matched healthy controls (HC). The CT group underwent brain MRI and the NIH Toolbox for Cognition testing prior to adjuvant chemotherapy (time point 1, TP1) and within 1 month after chemotherapy (time point 2, TP2). The HC group underwent the same assessments at matched intervals. GMD was evaluated with the voxel-based morphometry.
RESULTS: The mean age was 67 years in the CT group and 68.5 years in the HC group. There was significant GMD reduction within the chemotherapy group from TP1 to TP2. Compared to the HC group, the CT group displayed statistically significantly greater GMD reductions from TP1 to TP2 in the brain regions involving the left anterior cingulate gyrus, right insula, and left middle temporal gyrus (pFWE(family-wise error)-corrected<0.05). The baseline GMD in left insula was positively correlated with the baseline list-sorting working memory score in the HC group (pFWE-corrected<0.05). No correlation was observed for the changes in GMD with the changes in cognitive testing scores from TP1 to TP2 (pFWE-corrected<0.05).
CONCLUSIONS: Our findings indicate that GMD reductions were associated with adjuvant chemotherapy in older women with breast cancer. Future studies are needed to understand the clinical significance of the neuroimaging findings. This study is registered on ClinicalTrials.gov (NCT01992432).
KEYWORDS: Breast cancer Chemotherapy Cognition Gray matter density (GMD) Voxel-based morphometry (VBM)
DOI: 10.1007/s10549-018-4911-y
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