Prasad Sandip M, Eggener Scott E, Lipsitz Stuart R, Irwin Michael R, Ganz Patricia A, Hu Jim C
Sandip M. Prasad, Medical University of South Carolina, Charleston, SC; Scott E. Eggener, University of Chicago Medical Center, Chicago, IL; Stuart R. Lipsitz, Brigham and Women's Hospital, Boston, MA; Michael R. Irwin and Patricia A. Ganz, David Geffen School of Medicine at the University of California, Los Angeles; and Jim C. Hu, University of California, Los Angeles, Los Angeles, CA.
J Clin Oncol. 2014 Aug 10;32(23):2471-8. doi: 10.1200/JCO.2013.51.1048. Epub 2014 Jul 7.
Although demographic, clinicopathologic, and socioeconomic differences may affect treatment and outcomes of prostate cancer, the effect of mental health disorders remains unclear. We assessed the effect of previously diagnosed depression on outcomes of men with newly diagnosed prostate cancer.
We performed a population-based observational cohort study using Surveillance, Epidemiology, and End Results-Medicare linked data of 41,275 men diagnosed with clinically localized prostate cancer from 2004 to 2007. We identified 1,894 men with a depressive disorder in the 2 years before the prostate cancer diagnosis and determined its effect on treatment and survival.
Men with depressive disorder were older, white or Hispanic, unmarried, resided in nonmetropolitan areas and areas of lower median income, and had more comorbidities (P < .05 for all), but there was no variation in clinicopathologic characteristics. In adjusted analyses, men with depressive disorder were more likely to undergo expectant management for low-, intermediate-, and high-risk disease (P ≤ .05, respectively). Conversely, depressed men were less likely to undergo definitive therapy (surgery or radiation) across all risk strata (P < .01, respectively). Depressed men experienced worse overall mortality across risk strata (low: relative risk [RR], 1.86; 95% CI, 1.48 to 2.33; P < .001; intermediate: RR, 1.25; 95% CI, 1.06 to 1.49; P = .01; high: RR, 1.16; 95% CI, 1.03 to 1.32; P = .02).
Men with intermediate- or high-risk prostate cancer and a recent diagnosis of depression are less likely to undergo definitive treatment and experience worse overall survival. The effect of depression disorders on prostate cancer treatment and survivorship warrants further study, because both conditions are relatively common in men in the United States.
尽管人口统计学、临床病理及社会经济差异可能影响前列腺癌的治疗及预后，但心理健康障碍的影响仍不明确。我们评估了先前诊断的抑郁症对新诊断前列腺癌男性患者预后的影响。
我们利用2004年至2007年监测、流行病学及最终结果-医疗保险关联数据，开展了一项基于人群的观察性队列研究，纳入41275例诊断为临床局限性前列腺癌的男性。我们确定了1894例在前列腺癌诊断前2年内患有抑郁症的男性，并确定其对治疗及生存的影响。
患有抑郁症的男性年龄更大，为白人或西班牙裔，未婚，居住在非都市地区及中等收入较低的地区，且合并症更多（所有P <.05），但临床病理特征无差异。在多因素分析中，患有抑郁症的男性更有可能对低、中、高风险疾病采取观察等待治疗（分别为P≤.05）。相反，在所有风险分层中，抑郁男性接受确定性治疗（手术或放疗）的可能性较小（分别为P <.01）。抑郁男性在各风险分层中的总体死亡率更高（低风险：相对风险[RR]，1.86；95%置信区间，1.48至2.33；P <.001；中等风险：RR，1.25；95%置信区间，1.06至1.49；P =.01；高风险：RR，1.16；95%置信区间，1.03至1.32；P =.02）。
患有中高危前列腺癌且近期诊断为抑郁症的男性接受确定性治疗的可能性较小，总体生存率较差。抑郁症对前列腺癌治疗及生存的影响值得进一步研究，因为这两种情况在美国男性中都相对常见。
