乳腺癌患者内分泌治疗相关认知障碍：已发表研究的证据

　　内分泌为基础的治疗是绝经后乳腺癌女性患者的主要疗法，但有人顾虑其可能对认知（包括感觉、知觉、记忆、思维、想象、语言）产生不良影响。

　　2016年7月18日，施普林格旗下《乳腺癌研究与治疗》在线发表不列颠哥伦比亚大学、加拿大脑健康中心、森尼布鲁克健康科学中心、多伦多大学、多伦多女子学院、加拿大临床评价科学研究所的研究报告，对已发表文章进行系统回顾，评估内分泌为基础乳腺癌治疗方式与患者认知之间的相关性，以及年龄对两者的相关性是否有影响。

　　作者通过文献检索，共筛选出21项研究（n=2398），其中短期（持续≤2年）研究10项、长期（持续＞2年）研究11项、样本量≤100的研究9项（43%）、在治疗开始前进行基线测试的纵向研究9项（43%），无原始随机临床研究。虽然所用神经心理测试存在异质性，但是可以根据评定的认知领域进行分组。与乳腺癌或健康对照者相比，内分泌疗法与神经心理测试受损表现有相关性。无研究探讨年龄与认知表现变化之间的相关性。

　　总之，内分泌疗法与手术和健康对照者相比，存在较高的认知功能障碍相关性；但是，缺乏随机研究数据，并且许多研究设计存在异质性，限制了任何明确结论。虽然老年女性发生认知障碍的风险最高，但是高龄尚未得到充分探讨。

Breast Cancer Res Treat. 2016 Jul 18. [Epub ahead of print]

Endocrine treatment-associated cognitive impairment in breast cancer survivors: evidence from published studies.

Lee PE, Tierney MC, Wu W, Pritchard KI, Rochon PA.

University of British Columbia, Vancouver, BC, Canada; Centre for Brain Health, Vancouver, BC, Canada; Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Canada; Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada; Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.

Endocrine-based treatments are the mainstay of therapy for postmenopausal women with breast cancer; yet concern has been raised about potential adverse cognitive effects. We performed a systematic review of the published literature to evaluate whether endocrine-based treatments for breast cancer are associated with changes in cognitive domains and whether these effects are more pronounced with advanced age. An electronic database search was performed. Original investigations that examined the effects of endocrine treatment on cognitive function were identified. Data were abstracted and studies were assessed for risk of bias. A total of 21 unique studies (n = 2398) were identified. Ten were short-term (duration ≤ 2 years) and 11 were long-term (duration > 2 years). Nine (43 %) studies had a sample size ≤100 subjects; 9 (43 %) were longitudinal, with baseline measurement before treatment initiation. No studies were primary randomized clinical trials. While there was heterogeneity in the neuropsychological measures used, tests could be grouped into the cognitive domains that they assessed. Compared to breast cancer or healthy controls, endocrine therapy was associated with impaired performance on neuropsychological testing. No study explored the association between age and changes in cognitive performance. Overall, endocrine therapies were associated with greater cognitive deficits compared to surgical and healthy controls; yet, lack of randomized trial data and heterogeneity in design of many studies limited any definitive conclusions. Despite older women being at highest risk for the development of cognitive impairment, advanced age has not been adequately explored.

KEYWORDS: Aged; Antineoplastic agents, hormonal; Breast neoplasm; Cognition disorders

PMID: 27432418

DOI: 10.1007/s10549-016-3906-9