Akechi Tatsuo, Okamura Hitoshi, Okuyama Toru, Furukawa Toshiaki A, Nishiwaki Yutaka, Uchitomi Yosuke
Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
Psychooncology. 2009 Jan;18(1):23-9. doi: 10.1002/pon.1364.
Although several previous studies have investigated the association between psychosocial factors and the survival of lung cancer patients, most previous studies were flawed by severe methodological limitations. The purpose of the present study was to use a rigorous study design to investigate the association between relevant psychosocial factors and survival after a diagnosis of inoperable non-small cell lung cancer (NSCLC).
The subjects were 122 consecutive newly diagnosed patients with inoperable NSCLC. Patients coping with cancer, psychological distress, clinical depression, and social support were evaluated after diagnosis but before treatment and 2 months later. After a 2-year follow-up period, 108 patients had died. The survival data were censored for the remaining 14 patients. The influence of psychosocial factors after diagnosis but before treatment on survival time was analyzed using a Cox regression, with adjustments for well-established (definite and/or possible) prognostic factors. The stability of the investigated psychosocial factors was also examined.
None of the examined psychosocial factors significantly predicted survival time among the patients with inoperable NSCLC. Among the biomedical factors that were examined, advanced clinical stage, a high serum lactate dehydrogenase level, and not receiving chemotherapy were independently associated with shorter survival periods. Most of the psychosocial factors exhibited a moderate to high stability.
We found little convincing evidence that psychosocial factors after cancer diagnosis had a clinically relevant effect on the survival of inoperable patients with NSCLC.
尽管先前已有多项研究调查了社会心理因素与肺癌患者生存率之间的关联，但大多数先前研究存在严重的方法学局限性。本研究的目的是采用严谨的研究设计，调查相关社会心理因素与不可手术的非小细胞肺癌（NSCLC）诊断后生存率之间的关联。
研究对象为122例连续新诊断的不可手术NSCLC患者。在诊断后但治疗前以及2个月后对患者应对癌症的情况、心理困扰、临床抑郁和社会支持进行评估。经过2年的随访期，108例患者死亡。对其余14例患者的生存数据进行了截尾处理。采用Cox回归分析诊断后但治疗前的社会心理因素对生存时间的影响，并对已确定的（明确和/或可能的）预后因素进行调整。还检查了所调查的社会心理因素的稳定性。
在不可手术的NSCLC患者中，所检查的社会心理因素均未显著预测生存时间。在所检查的生物医学因素中，临床晚期、血清乳酸脱氢酶水平高和未接受化疗与较短的生存期独立相关。大多数社会心理因素表现出中度至高稳定性。
我们几乎没有找到令人信服的证据表明癌症诊断后的社会心理因素对不可手术的NSCLC患者的生存有临床相关影响。
