Research advances of the effects of neoadjuvant chemotherapy on postoperative cognitive function in cancer patients

doi:10.11958/20253033

Abstract

Abstract:

Neoadjuvant chemotherapy plays a significant role in tumor treatment, but it can lead to postoperative cognitive dysfunction. Studies have shown that the neurotoxicity of different chemotherapy drugs varies significantly and is dose-dependent, especially for high-risk groups such as the elderly and those with underlying diseases.The mechanisms of postoperative cognitive impairment involve multiple factors such as neuroinflammation, oxidative stress, blood-brain barrier disruption and inhibition of hippocampal neurogenesis. To address this issue, multi-dimensional intervention strategies should be adopted, including optimizing chemotherapy regimens and applying neuroprotective agents. Future research should focus on long-term follow-up, mechanism exploration and precise intervention to balance the anti-tumor efficacy and cognitive function protection, and further improve the quality of life of patients.

Key words: chemotherapy, adjuvant, chemotherapy-related cognitive impairment, neoplasms, neurotoxicity

CLC Number:

R453.9

Figures/Tables 3

References 37

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药物类别	代表药物	神经毒性表现	对认知功能的影响
烷化剂	环磷酰胺	周围神经病变、可逆性认知障碍	短期记忆减退、注意力分散
抗代谢药	甲氨蝶呤	中枢神经系统毒性（脑膜炎、脑病）	执行功能下降、语言流畅性降低
植物类生物碱	紫杉醇、长春新碱	周围神经病变（感觉异常、疼痛）	精细动作协调障碍，影响认知任务执行
铂类	顺铂、奥沙利铂	周围神经病变（剂量依赖性）、耳鸣	信息处理速度减慢、视觉空间能力下降
蒽环类	阿霉素	较少直接神经毒性，但可通过氧化应激间接影响	可能与长期记忆损害相关

药物类别	代表药物	神经毒性表现	对认知功能的影响
烷化剂	环磷酰胺	周围神经病变、可逆性认知障碍	短期记忆减退、注意力分散
抗代谢药	甲氨蝶呤	中枢神经系统毒性（脑膜炎、脑病）	执行功能下降、语言流畅性降低
植物类生物碱	紫杉醇、长春新碱	周围神经病变（感觉异常、疼痛）	精细动作协调障碍，影响认知任务执行
铂类	顺铂、奥沙利铂	周围神经病变（剂量依赖性）、耳鸣	信息处理速度减慢、视觉空间能力下降
蒽环类	阿霉素	较少直接神经毒性，但可通过氧化应激间接影响	可能与长期记忆损害相关

药物类型	代表药物	作用机制	临床证据等级
抗氧化剂	维生素E、硫辛酸	清除自由基，抑制氧化应激	Ⅱ级（多项 RCT 显示可改善主观认知症状）
神经营养因子	脑源性神经营养因子（BDNF）	促进神经细胞存活与突触可塑性	Ⅲ级（动物实验有效，临床Ⅱ期试验中）
抗炎药物	米诺环素	抑制小胶质细胞过度激活	Ⅱ级（可降低脑脊液IL-6水平，但对认知功能改善证据有限）
胆碱酯酶抑制剂	多奈哌齐	提高脑内乙酰胆碱水平	Ⅱ级（术后短期使用可改善记忆测试成绩）

药物类型	代表药物	作用机制	临床证据等级
抗氧化剂	维生素E、硫辛酸	清除自由基，抑制氧化应激	Ⅱ级（多项 RCT 显示可改善主观认知症状）
神经营养因子	脑源性神经营养因子（BDNF）	促进神经细胞存活与突触可塑性	Ⅲ级（动物实验有效，临床Ⅱ期试验中）
抗炎药物	米诺环素	抑制小胶质细胞过度激活	Ⅱ级（可降低脑脊液IL-6水平，但对认知功能改善证据有限）
胆碱酯酶抑制剂	多奈哌齐	提高脑内乙酰胆碱水平	Ⅱ级（术后短期使用可改善记忆测试成绩）