Psycho-oncology · 2026
Neurotrophic-Inflammatory Imbalance and Cognitive Decline After Adjuvant Chemotherapy in Colon Cancer: A Prospective Cohort Study.
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Güç Zeynep Gülsüm, Demir Leyla, Döngelli Hüseyin, Bilen İbrahim, Uge Mert, Kalender Mehmet Eren, Alacacıoğlu Ahmet, Tarhan Mustafa Oktay
Аннотация
BACKGROUND: Cancer-related cognitive impairment (CRCI) is a prevalent yet underrecognized complication among colon cancer survivors that adversely affects quality of life and psychological well-being. Emerging evidence suggests that neurotrophic dysregulation and systemic inflammation may contribute to chemotherapy-related neurotoxicity; however, longitudinal biomarker-based data remain limited.
METHODS: In this prospective cohort study, 127 patients with resected colon cancer were evaluated at baseline and at the 6-month follow-up. Of these, 83 received adjuvant chemotherapy and 44 underwent postoperative surveillance alone. Cognitive performance (MoCA), depressive symptoms (HADS-D), and peripheral neuropathy (CIPN20) were assessed alongside serum brain-derived neurotrophic factor (BDNF) levels and systemic inflammatory markers, including neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein-to-albumin ratio (CAR). Linear mixed model and logistic regression analyses were performed to identify factors associated with cognitive decline.
RESULTS: Adjuvant chemotherapy was associated with significant reductions in MoCA scores and serum BDNF levels (both p < 0.001), particularly among patients receiving the oxaliplatin-based XELOX regimen. Greater longitudinal reductions in BDNF (ΔBDNF) were independently associated with higher odds of CRCI (OR = 0.749 per 10 ng/mL increase in ΔBDNF, 95% CI: 0.658-0.854, p < 0.001). The model including ΔBDNF showed higher apparent discrimination than the corresponding model without ΔBDNF (AUC = 0.929 vs. 0.812).
CONCLUSION: Longitudinal reductions in serum BDNF were independently associated with CRCI among patients receiving adjuvant chemotherapy. These findings support a potential role for neurotrophic dysregulation in chemotherapy-related cognitive decline and highlight the need for further validation studies evaluating BDNF as a candidate biomarker for CRCI.
METHODS: In this prospective cohort study, 127 patients with resected colon cancer were evaluated at baseline and at the 6-month follow-up. Of these, 83 received adjuvant chemotherapy and 44 underwent postoperative surveillance alone. Cognitive performance (MoCA), depressive symptoms (HADS-D), and peripheral neuropathy (CIPN20) were assessed alongside serum brain-derived neurotrophic factor (BDNF) levels and systemic inflammatory markers, including neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein-to-albumin ratio (CAR). Linear mixed model and logistic regression analyses were performed to identify factors associated with cognitive decline.
RESULTS: Adjuvant chemotherapy was associated with significant reductions in MoCA scores and serum BDNF levels (both p < 0.001), particularly among patients receiving the oxaliplatin-based XELOX regimen. Greater longitudinal reductions in BDNF (ΔBDNF) were independently associated with higher odds of CRCI (OR = 0.749 per 10 ng/mL increase in ΔBDNF, 95% CI: 0.658-0.854, p < 0.001). The model including ΔBDNF showed higher apparent discrimination than the corresponding model without ΔBDNF (AUC = 0.929 vs. 0.812).
CONCLUSION: Longitudinal reductions in serum BDNF were independently associated with CRCI among patients receiving adjuvant chemotherapy. These findings support a potential role for neurotrophic dysregulation in chemotherapy-related cognitive decline and highlight the need for further validation studies evaluating BDNF as a candidate biomarker for CRCI.
Предметные рубрики MeSH
HumansFemaleProspective StudiesBrain-Derived Neurotrophic FactorMaleColonic NeoplasmsChemotherapy, AdjuvantAgedOxaliplatinMiddle AgedInflammationC-Reactive ProteinAntineoplastic Combined Chemotherapy ProtocolsOxaloacetatesBiomarkersFluorouracilCapecitabineChemotherapy-Related Cognitive ImpairmentDepressionPeripheral Nervous System DiseasesCognitive Dysfunction