Nis P. Suppli, Christoffer Johansen, and Susanne O. Dalton, Danish Cancer Society Research Center; Nis P. Suppli, Christoffer Johansen, Lars V. Kessing, and Niels Kroman, Rigshospitalet, Copenhagen; Anita Toender, Aarhus University, Aarhus; and Marianne Ewertz, Odense University Hospital, University of Southern Denmark, Odense, Denmark.
J Clin Oncol. 2017 Jan 20;35(3):334-342. doi: 10.1200/JCO.2016.68.8358. Epub 2016 Nov 14.
Purpose The aim of this nationwide, register-based cohort study was to determine whether women treated for depression before primary early-stage breast cancer are at increased risk for receiving treatment that is not in accordance with national guidelines and for poorer survival. Material and Methods We identified 45,325 women with early breast cancer diagnosed in Denmark from 1998 to 2011. Of these, 744 women (2%) had had a previous hospital contact (as an inpatient or outpatient) for depression and another 6,068 (13%) had been treated with antidepressants. Associations between previous treatment of depression and risk of receiving nonguideline treatment of breast cancer were assessed in multivariable logistic regression analyses. We compared the overall survival, breast cancer-specific survival, and risk of death by suicide of women who were and were not treated for depression before breast cancer in multivariable Cox regression analyses. Results Tumor stage did not indicate a delay in diagnosis of breast cancer in women previously treated for depression; however, those given antidepressants before breast cancer had a significantly increased risk of receiving nonguideline treatment (odds ratio, 1.14; 95% CI, 1.03 to 1.27) and significantly worse overall survival (hazard ratio, 1.21; 95% CI, 1.14 to 1.28) and breast cancer-specific survival (hazard ratio, 1.11; 95% CI, 1.03 to 1.20). Increased but nonsignificant estimated risks were also found for women with previous hospital contacts for depression. In subgroup analyses, the association of depression with poor survival was particularly strong among women who did not receive the indicated adjuvant systemic therapy. Conclusion Women previously treated for depression constitute a large subgroup of patients with breast cancer who are at risk for receiving nonguideline breast cancer treatment, which probably contributes to poorer overall and breast cancer-specific survival.
目的 本全国性基于登记的队列研究旨在确定患有早期原发性乳腺癌之前接受过抑郁症治疗的女性是否有更高的风险接受不符合国家指南的治疗以及生存状况更差。
材料和方法 我们在丹麦确定了 1998 年至 2011 年间诊断出患有早期乳腺癌的 45325 名女性。其中，744 名女性（2%）有过抑郁症的既往住院治疗（住院或门诊），6068 名女性（13%）接受过抗抑郁药物治疗。使用多变量逻辑回归分析评估了既往抑郁症治疗与接受非指南治疗乳腺癌风险之间的关联。我们在多变量 Cox 回归分析中比较了乳腺癌前接受和未接受抑郁症治疗的女性的总生存率、乳腺癌特异性生存率和自杀死亡风险。
结果 先前接受过抑郁症治疗的女性乳腺癌的诊断并未出现延迟；然而，在乳腺癌之前接受抗抑郁药物治疗的女性接受非指南治疗的风险显著增加（比值比，1.14；95%置信区间，1.03 至 1.27），且总体生存率（风险比，1.21；95%置信区间，1.14 至 1.28）和乳腺癌特异性生存率（风险比，1.11；95%置信区间，1.03 至 1.20）显著更差。先前有过住院治疗抑郁症的女性也发现了风险增加但无统计学意义的估计值。在亚组分析中，抑郁症与不良生存之间的关联在未接受规定辅助全身治疗的女性中尤为强烈。
结论 之前接受过抑郁症治疗的女性是乳腺癌患者的一个大亚组，她们有接受非指南乳腺癌治疗的风险，这可能导致总体生存率和乳腺癌特异性生存率更差。
