Liang Xiaoyun, Margolis Karen L, Hendryx Michael, Reeves Katherine, Wassertheil-Smoller Sylvia, Weitlauf Julie, Danhauer Suzanne C, Chlebowski Rowan T, Caan Bette, Qi Lihong, Lane Dorothy, Lavasani Sayeh, Luo Juhua
School of Social Development and Public Policy, Beijing Normal University, Beijing, China.
HealthPartners Institute, Minneapolis, Minnesota.
Cancer. 2017 Aug 15;123(16):3107-3115. doi: 10.1002/cncr.30688. Epub 2017 Apr 7.
Few previous studies investigating depression before the diagnosis of breast cancer and breast cancer-specific mortality have examined depression measured at more than 1 time point. This study investigated the effect of depression (combining depressive symptoms alone with antidepressant use) measured at 2 time points before the diagnosis of breast cancer on all-cause mortality and breast cancer-specific mortality among older postmenopausal women.
A large prospective cohort, the Women's Health Initiative, was used. The study included 3095 women with incident breast cancer who had measures of depressive symptoms and antidepressant use before their diagnosis at the baseline and at year 3. Multivariate Cox proportional hazards regression was used to estimate adjusted hazard ratios (HRs) between depression at the baseline, depression at year 3, and combinations of depression at these time points and all-cause mortality and breast cancer-specific mortality.
Depression at year 3 before a breast cancer diagnosis was associated with higher all-cause mortality after adjustments for multiple covariates (HR, 1.35; 95% confidence interval [CI], 1.02-1.78). There was no statistically significant association of baseline depression and all-cause mortality or breast cancer-specific mortality whether or not depression was also present at year 3. In women with late-stage (regional- or distant-stage) breast cancer, newly developed depression at year 3 was significantly associated with both all-cause mortality (HR, 2.00; 95% CI, 1.13-3.56) and breast cancer-specific mortality (HR, 2.42; 95% CI, 1.24-4.70).
Women with newly developed depression before the diagnosis of breast cancer had a modestly but significantly increased risk for death from any cause and for death from breast cancer at a late stage. Cancer 2017;123:3107-15. © 2017 American Cancer Society.
既往很少有研究在乳腺癌诊断前调查抑郁症情况以及乳腺癌特异性死亡率，这些研究中测量抑郁症的时间点不超过1个。本研究调查了在乳腺癌诊断前两个时间点测量的抑郁症（将单纯抑郁症状与使用抗抑郁药相结合）对老年绝经后女性全因死亡率和乳腺癌特异性死亡率的影响。
使用了一个大型前瞻性队列——妇女健康倡议研究。该研究纳入了3095例新发乳腺癌女性，她们在基线期和第3年诊断前有抑郁症状测量和抗抑郁药使用情况。采用多变量Cox比例风险回归来估计基线期抑郁症、第3年抑郁症以及这些时间点抑郁症组合与全因死亡率和乳腺癌特异性死亡率之间的校正风险比（HR）。
在对多个协变量进行校正后，乳腺癌诊断前第3年的抑郁症与较高的全因死亡率相关（HR，1.35；95%置信区间[CI]，1.02 - 1.78）。无论第3年是否也存在抑郁症，基线期抑郁症与全因死亡率或乳腺癌特异性死亡率均无统计学显著关联。在晚期（局部或远处期）乳腺癌女性中，第3年新出现的抑郁症与全因死亡率（HR，2.00；95% CI，1.13 - 3.56）和乳腺癌特异性死亡率（HR，2.42；95% CI，1.24 - 4.70）均显著相关。
在乳腺癌诊断前新出现抑郁症的女性，全因死亡和晚期乳腺癌死亡风险有适度但显著的增加。《癌症》2017年；123:3107 - 15。© 2017美国癌症协会。
