Antoni Michael H, Jacobs Jamie M, Bouchard Laura C, Lechner Suzanne C, Jutagir Devika R, Gudenkauf Lisa M, Blomberg Bonnie B, Glück Stefan, Carver Charles S
Department of Psychology, University of Miami, Coral Gables, Florida.
Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida.
Gen Hosp Psychiatry. 2017 Jan-Feb;44:16-21. doi: 10.1016/j.genhosppsych.2016.10.002. Epub 2016 Oct 22.
Mild to moderate depressive symptoms are common during treatment for non-metastatic breast cancer. The goal of this secondary analysis was to determine if depressive symptoms predict clinical outcomes at long-term follow-up.
From 1998 to 2005, we interviewed 231 women with the Hamilton Rating Scale for Depression who were participating in a psychosocial study 2-10weeks post-surgery for non-metastatic breast cancer (Stage 0-IIIb). We conducted Kaplan Meier (K-M) curves and Cox proportional hazards (PH) models to examine associations between depressive symptoms, overall survival, and disease-free survival at 8-15-year follow-up.
A total of 95 women (41.1%) scored in the mild-moderately depressed range. Non-depressed women had longer overall survival (M=13.56years; SE=0.26) than those in the mild/moderate depressed group (M=11.45years; SE=0.40), Log-rank χ(1)=4.41, p=0.036. Cox PH models, adjusting for covariates, showed comparable results: mild/moderate depressive symptoms hazard ratio=2.56, [95% CI, 1.11 to 5.91], p=0.027. Similar results were observed in a subsample with invasive disease (n=191). Depression category did not predict disease-free survival in the overall or invasive sample.
Screening and referrals for treatment of depressive symptoms, even at subclinical levels, is important early in treatment. A randomized trial is warranted to determine effects of depressive symptoms on clinical outcomes.
在非转移性乳腺癌治疗期间，轻至中度抑郁症状很常见。这项二次分析的目的是确定抑郁症状是否能预测长期随访的临床结局。
1998年至2005年，我们用汉密尔顿抑郁量表对231名非转移性乳腺癌（0-IIIb期）术后2-10周参与社会心理研究的女性进行了访谈。我们绘制了Kaplan Meier（K-M）曲线和Cox比例风险（PH）模型，以检验抑郁症状、总生存期和无病生存期在8-15年随访中的关联。
共有95名女性（41.1%）得分处于轻度至中度抑郁范围。非抑郁女性的总生存期（M=13.56年；标准误=0.26）长于轻度/中度抑郁组（M=11.45年；标准误=0.40），对数秩检验χ(1)=4.41，p=0.036。调整协变量后的Cox PH模型显示了类似结果：轻度/中度抑郁症状风险比=2.56，[95%置信区间，1.11至5.91]，p=0.027。在患有浸润性疾病的子样本（n=191）中也观察到了类似结果。抑郁类别在总体样本或浸润性样本中均不能预测无病生存期。
即使在亚临床水平，对抑郁症状进行筛查和转诊治疗在治疗早期也很重要。有必要进行一项随机试验来确定抑郁症状对临床结局的影响。
