| Objective: There is significant heterogeneity in chemotherapy-related cognitive impairment(CRCI)in breast cancer patients,and its specific mechanism is still unclear,whether it is related to the expression of hormone receptors is not clear.The purpose of this study was to investigate the possible neurophysiological mechanisms of the CRCI in breast cancer patients.Methods: Forty postoperative breast cancer patients were enrolled in this study and were divided into two groups.The HR+ group was composed of twenty-one patients with ER+/PR+ status,and the HR-group included nineteen patients with ER-/PR-status.A battery of neuropsychological tests and resting-state functional magnetic resonance imaging(rs-fMRI)examinations were administered to all subjects before and after chemotherapy.RS-fMRI data processing software was used to analyze and record the different brain regions.Then,ReHo,ALFF and FC values in the corresponding brain regions were calculated.Finally,correlation analysis was conducted between ReHo,ALFF and FC values in the brain regions with statistical differences and the results of neuropsychological tests.Results:(1)Before and after chemotherapy,MMSE(29.14±0.91 vs 26.10±1.92)?VFT(11.76±2.76 vs 6.95±0.86)?DST(6.29±0.85 vs 5.14±0.98)PM(10.86±1.85 vs 18.90±3.97)?RM(10.14±1.59 vs 18.29±2.22)of breast cancer patients in the HR+ group had statistically significant differences(t=6.216,7.668,4.678,-9.383,-15.729;P < 0.01).Before and after chemotherapy,MMSE(29.05±0.85 vs 23.84±2.29)?VFT(11.32±1.67 vs 5.58±1.68)?DST(6.47±0.90 vs 4.37±1.34)?PM(10.95±1.65 vs 21.58±3.66)?RM(10.16±1.57 vs 21.16±2.32)of breast cancer patients in the HR-group had statistically significant differences(t=8.683,11.203,6.419,-11.458,-17.706;P < 0.01).Compared with the HR+ group,the MMSE(26.10±1.92 vs 23.84±2.29),VFT(6.95±0.86 vs 5.58±1.68),DST(5.14±0.98 vs 4.37±1.34)of the HR-group after chemotherapy were significantly lower than those of the HR+ group(t=3.381,3.205,2.101;p<0.05).The scores of PM(18.90±3.97 vs 21.58±3.66),RM(18.29±2.22 vs 21.16±2.32)were significantly higher than those in the HR+ group(t=-2.207,-4.006;p<0.05).However,there was no significant difference on cognitive function between the HR+ group and the HR-group breast cancer patients before chemotherapy(p>0.05).(2)Compared with breast cancer patients in the HR+ group,brain regions with increased ReHo after chemotherapy in the HR-group included right middle cingulate gyrus,left middle frontal gyrus,and left middle temporal gyrus.Brain regions with decreased ReHo were right superior frontal gyrus and right superior temporal gyrus.The brain regions with increased ALFF were anterior cingulate gyrus,left inferior frontal gyrus,and right medial prefrontal cortex.Compared with the HR+ group,the functional connectivity between the left dorsolateral prefrontal cortex and the left precuneus,the right dorsolateral prefrontal cortex with the right precuneus and the right superior frontal gyrus were significantly increased in the HR-group after chemotherapy.(3)In the HR-group breast cancer patients after chemotherapy,there was a correlation between the ReHo value in the right middle cingulate gyrus and the scores of MMSE and RM(r=-0.619,0.544;P=0.005,0.014),the ReHo value of right superior frontal gyrus was correlated with MMSE score(r=0.532,P=0.019),the ReHo value of right superior temporal gyrus was correlated with DST score(r=0.567,P=0.011),and the ALFF value of anterior cingulate gyrus was correlated with RM score(r=0.557,P=0.013).A significant positive correlation was observed between the FC of the left DLPFC with left precuneus and the PM score in the HR-group patients.(r=0.444,P=0.02).Conclusion: The cognitive impairment of breast cancer patients with negative hormone receptor expression is more significant than that patients with positive hormone receptor expression after chemotherapy,and the changes of rs-fMRI in different brain regions may be related to the heterogeneity of chemotherapy-related cognitive impairment in breast cancer patients. |
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