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. 2015 Nov 4;10(11):e0140655.
doi: 10.1371/journal.pone.0140655. eCollection 2015.

Postoperative Structural Brain Changes and Cognitive Dysfunction in Patients with Breast Cancer

Chiho Sato  1   2 , Atsushi Sekiguchi  1   3   4 , Masaaki Kawai  5 , Yuka Kotozaki  6 , Rui Nouchi  7   8   9 , Hiroshi Tada  2 , Hikaru Takeuchi  10 , Takanori Ishida  2 , Yasuyuki Taki  3   10   11 , Ryuta Kawashima  1   8   10 , Noriaki Ohuchi  2
Affiliations

Postoperative Structural Brain Changes and Cognitive Dysfunction in Patients with Breast Cancer

Chiho Sato et al. PLoS One. .

Abstract

Objective: The primary purpose of this study was to clarify the influence of the early response to surgery on brain structure and cognitive function in patients with breast cancer. It was hypothesized that the structure of the thalamus would change during the early response after surgery due to the effects of anesthesia and would represent one aspect of an intermediate phenotype of postoperative cognitive dysfunction (POCD).

Methods: We examined 32 postmenopausal females with breast cancer and 20 age-matched controls. We assessed their cognitive function (attention, memory, and executive function), and performed brain structural MRI 1.5 ± 0.5 days before and 5.6 ± 1.2 days after surgery.

Results: We found a significant interaction between regional grey matter volume (rGMV) in the thalamus (P < 0.05, familywise error (FWE), small volume correction (SVC)) and one attention domain subtest (P = 0.001, Bonferroni correction) after surgery in the patient group compared with the control group. Furthermore, the changes in attention were significantly associated with sevoflurane anesthetic dose (r2 = 0.247, β = ‒0.471, P = 0.032) and marginally associated with rGMV changes in the thalamus (P = 0.07, FWE, SVC) in the Pt group.

Conclusion: Our findings suggest that alterations in brain structure, particularly in the thalamus, may occur shortly after surgery and may be associated with attentional dysfunction. This early postoperative response to anesthesia may represent an intermediate phenotype of POCD. It was assumed that patients experiencing other risk factors of POCD, such as the severity of surgery, the occurrence of complications, and pre-existing cognitive impairments, would develop clinical POCD with broad and multiple types of cognitive dysfunction.

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Conflict of interest statement

Competing Interests: This study was conducted using a grant (A Grant-in-Aid for Scientists (KAKENHI) from the Ministry of Education, Culture, Sports, Science and Technology etc.). Ryuta Kawashima, the principal investigator, receives royalty income from Nintendo Inc. "Nintendo 3DS", "ONI training", "Tetris" which are products of Nintendo Inc., which were planned to be used in an intervention study involved in the whole protocol of "Neurological underpinnings of cognitive dysfunction in breast cancer patients." However, this study did not employ intervention using these games. This does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Enrollment, Participation, Follow-up, and Analysis of the patient group.
Fig 2
Fig 2. Association between attention (D-CAT1) and anesthesia (sevoflurane) in the patient group.
Residual plots with trend lines depicting the correlations between residuals in the multiple regression analyses, using the change ratio of D-CAT1 scores as the dependent variable, and the total dose of sevoflurane and other confounding factors as independent variables. Two patients who did not receive post-operative examination and 2 patients who were assigned as outliers of the sevoflurane dose were removed from the analysis. Therefore the data from 28 patients were analyzed. Abbreviations: D-CAT, digit cancellation task.
Fig 3
Fig 3. Regions showing the significant group (Pt/HC) by time (pre/post) interactions (right thalamus; p < 0.05, SVC).
The colored bar shows the scale of the t-value. Abbreviations: Rt, right; Pt, patients; HC, healthy controls; Pre, before surgery; Post, after surgery.
See this image and copyright information in PMC

References

    1. Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer. 2010;127(12):2893–917. Epub 2011/02/26. 10.1002/ijc.25516 - DOI - PubMed
    1. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin. 2011;61(2):69–90. Epub 2011/02/08. 10.3322/caac.20107 . - DOI - PubMed
    1. Matsuda T, Takayama T, Tashiro M, Nakamura Y, Ohashi Y, Shimozuma K. Mild Cognitive Impairment after Adjuvant Chemotherapy in Breast Cancer Patients—Evaluation of Appropriate Research Design and Methodology to Measure Symptoms. Breast Cancer. 2005;12. Epub 287. - PubMed
    1. Ahles TA, Saykin AJ, Furstenberg CT, Cole B, Mott LA, Titus-Ernstoff L, et al. Quality of life of long-term survivors of breast cancer and lymphoma treated with standard-dose chemotherapy or local therapy. J Clin Oncol. 2005;23(19):4399–405. Epub 2005/07/05. 10.1200/JCO.2005.03.343 - DOI - PMC - PubMed
    1. Ahles TA, Root JC, Ryan EL. Cancer- and cancer treatment-associated cognitive change: an update on the state of the science. J Clin Oncol. 2012;30(30):3675–86. Epub 2012/09/26. 10.1200/JCO.2012.43.0116 - DOI - PMC - PubMed

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