UCI主導の研究により、若年がん患者における治療前の認知機能障害が発見される(UCI-led study discovers pre-treatment cognitive impairment in younger cancer patients)

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診断時に毒性を評価・管理し、さらなる悪化を防ぐ必要があります。 Toxicity must be evaluated and managed at diagnosis to help prevent further deterioration

2022-11-15 カリフォルニア大学校アーバイン校(UCI)

研究チームは、思春期および若年成人のがん患者が化学療法や放射線治療前にがんに関連した認知機能障害を経験することを発見し、さらなる悪化を防ぐために診断時に毒性を評価し管理することの重要性を強調した。
この研究では、思春期および若年成人がん患者は、がん治療前に年齢を合わせた健康対照群に比べ、少なくとも2つの認知機能テストで3倍以上の低い結果を示していることがわかった。また、ベースラインの炎症性バイオマーカーが上昇し、血漿中の脳由来神経栄養因子レベルが低下していた。これは、脳における神経新生と神経細胞可塑性の低下を示していると考えられる。

<関連情報>

思春期および若年成人がん患者における認知機能障害:治療前の縦断的研究の結果 Cognitive impairment in adolescent and young adult cancer patients: Pre-treatment findings of a longitudinal study

Alexandre Chan,Ivy Cheng,Claire Wang,Chia Jie Tan,Yi Long Toh,Ding Quan Ng,Yong Qin Koh,Hanzhang Zhou,Koon Mian Foo,Raymond Javan Chan,Han Kiat Ho,Lita Chew,Mohamad Farid,Ian Tannock
Cancer Medicine  Published: 11 October 2022
DOI:https://doi.org/10.1002/cam4.5295

Abstract

Background
There is little information about cancer-related cognitive impairment (CRCI) in adolescent and young adults (AYA, 15–39 years old) due to its rare incidence. Here, we present the pre-treatment (before chemotherapy or radiotherapy) evaluation of cognitive function and ability of AYA with cancer (AYAC) in a multicentered cohort study.

Methods
Newly diagnosed AYAC and age-matched healthy controls (HC) were recruited between 2018 and 2021. The primary outcome was the comparison of pre-treatment cognitive impairment defined as 2 standard deviations (SDs) below the HC on ≥1 cognitive test, or >1.5 SDs below on ≥2 tests using CANTAB® between AYAC and HC. Secondary outcomes included self-perceived cognitive ability assessed by FACT-Cog v3 and biomarkers (inflammatory cytokines and brain-derived neurotrophic factor [BDNF]).

Results
We recruited 74 AYAC (median age = 34) and 118 HC (median age = 32). On objective cognitive testing, we observed three times more AYAC patients performed poorly on at least 2 cognitive tests compared to HC (40.5% vs. 13.6%, p < 0.001). AYAC self-perceived less degree of cognitive impairment than HC (p < 0.001). However, AYAC perceived a greater impact of cognitive changes on their quality of life compared to HC (p = 0.039). Elevated baseline inflammatory markers (IL-2, IL-4, IL-6, IL-8, IL-10 and IFN-γ) were observed among AYAC compared to HC, and baseline BDNF was lower in AYAC compared to HC. Interaction effects between cancer diagnosis and biomarkers were observed in predicting cognitive function.

Conclusion
With the pre-existence of CRCI and risk factors of neuroinflammation even prior to systemic therapy, AYAC should receive early rehabilitation to prevent further deterioration of cognitive function after initiation of systemic therapies. (ClinicalTrials.gov Identifier: NCT03476070).

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