Edinburgh Centre for Neuro-Oncology, Western General Hospital, Edinburgh, UK.
J Natl Cancer Inst. 2011 Jan 5;103(1):61-76. doi: 10.1093/jnci/djq458. Epub 2010 Nov 24.
Depression is a common and important complication of primary cerebral glioma. However, observational studies of this relationship have not been systematically reviewed.
We searched MEDLINE, EMBASE, and PsycINFO for all English-language cross-sectional, case-control, and cohort studies of depression in adults with primary glioma published between January 1, 1980, and September 16, 2009. We identified 42 eligible studies that recruited 4089 individual glioma patients. We conducted a narrative review of these studies regarding the heterogeneity in diagnostic methods, the frequency of depression and its clinical associations, and the quality of study reporting.
Most studies of depression in adults with glioma were small, cross-sectional, or retrospective. Depression was most often measured using the Hospital Anxiety and Depression Scale (HADS; n = 10 studies). The Beck Depression Inventory, another frequently used screening instrument, returned a higher frequency of depression (median = 39%, range = 38%-42%) than the Hospital Anxiety and Depression Scale (median = 16%, range = 0%-21%). At clinical interview, the median frequency of depression in glioma was 15% (range = 6%-28%). Depression was consistently associated with reduced physical function, cognitive impairment, and reduced quality of life. It may be associated with reduced survival, although evidence for this association was modest. There was an absence of clear associations between depression and many tumor-related variables. Few observational studies examined the treatment of depression in glioma patients. Multivariable analyses were rare, and study reporting was of variable quality.
In glioma, mild to moderate depressive symptoms may only rarely be due to tumor-associated structural or functional disruption of neuronal emotional networks. Improved methodological reporting would help clinicians better evaluate future studies, and facilitate improved evidence-based care of depressed glioma patients.
抑郁是原发性脑胶质瘤的常见且重要的并发症。然而，对于这种关系的观察性研究尚未得到系统评价。
我们检索了 MEDLINE、EMBASE 和 PsycINFO，以寻找 1980 年 1 月 1 日至 2009 年 9 月 16 日之间发表的所有关于原发性脑胶质瘤患者抑郁的英文的横断面研究、病例对照研究和队列研究。我们确定了 42 项符合条件的研究，共招募了 4089 名原发性脑胶质瘤患者。我们对这些研究进行了叙述性综述，涉及诊断方法的异质性、抑郁的频率及其临床相关性以及研究报告的质量。
大多数成人脑胶质瘤患者抑郁的研究规模较小、横断面或回顾性。抑郁最常用的测量方法是医院焦虑抑郁量表（HADS；n=10 项研究）。贝克抑郁量表是另一种常用的筛查工具，其测量的抑郁频率更高（中位数=39%，范围=38%-42%），而医院焦虑抑郁量表的测量结果为（中位数=16%，范围=0%-21%）。在临床访谈中，脑胶质瘤患者的抑郁中位数为 15%（范围=6%-28%）。抑郁与身体功能下降、认知障碍和生活质量下降始终相关。它可能与生存率降低相关，尽管这种关联的证据是有限的。抑郁与许多肿瘤相关变量之间没有明确的关联。很少有观察性研究研究了脑胶质瘤患者的抑郁治疗。多变量分析很少见，研究报告的质量也各不相同。
在脑胶质瘤中，轻度至中度抑郁症状可能很少是由于肿瘤引起的神经元情感网络的结构性或功能性破坏所致。改善方法学报告将有助于临床医生更好地评估未来的研究，并促进改善抑郁脑胶质瘤患者的循证护理。
