抑郁症与胶质瘤患者的生存率：一项系统评价与荟萃分析。
Depression and survival of glioma patients: A systematic review and meta-analysis.
作者信息
Shi C, Lamba Nayan, Zheng L J, Cote D, Regestein Q R, Liu C M, Tran Q, Routh S, Smith T R, Mekary R A, Broekman M L D
机构信息
Computational Neurosciences Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, United States; Harvard T.H. Chan School of Public Health, Boston, MA, United States.
Computational Neurosciences Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
出版信息
Clin Neurol Neurosurg. 2018 Sep;172:8-19. doi: 10.1016/j.clineuro.2018.06.016. Epub 2018 Jun 18.
INTRODUCTION
There is currently a lack of a well-formed consensus regarding the effects of depression on the survival of glioma patients. A more thorough understanding of such effects may better highlight the importance of recognizing depressive symptoms in this patient population and guide treatment plans in the future.
OBJECTIVE
The aim of this meta-analysis was to study the effect of depression on glioma patients' survival.
METHODS
A meta-analysis was conducted according to the PRISMA guidelines. PubMed, Embase, and Cochrane databases were searched for studies that reported depression and survival among glioma patients through 11/06/2016. Both random-effects (RE) and fixed-effect (FE) models were used to compare survival outcomes in glioma patients with and without depression.
RESULTS
Out of 619 identified articles, six were selected for the meta-analysis. Using RE model, the various measures for survival outcomes displayed worsened outcomes for both high and low-grade glioma patients with depression compared to those without depression. For binary survival outcomes, the overall pooled risk ratio for survival was 0.70 (95% CI: 0.47, 1.04; 6 studies; I = 54.9%, P-heterogeneity = 0.05) for high grade gliomas (HGG) and 0.28 (95% CI: 0.04, 1.78; I = 0%, P-heterogeneity = 1.00; one study) for low grade gliomas (LGG) was. A sub-group analysis in the HGG group by depression timing (pre- versus post-operative) revealed no differences between depression and survival outcomes (P-interaction = 0.47). For continuous survival outcomes, no statistically significant difference was found among the high and low-grade glioma groups (P-interaction = 0.31). The standardized mean difference (SMD) in survival outcomes was -0.56 months (95%CI: -1.13, 0.02; 4 studies, I = 89.4%, P-heterogeneity < 0.01) for HGG and -1.69 months (95%CI: -3.26, -0.13; one study; I = 0%, P-heterogeneity = 1.00) for LGG. In patients with HGG, the pooled HR of death also showed a borderline significant increased risk of death among depressive patients (HR 1.42, 95% CI: 1.00, 2.01). Results using the FE model were not materially different.
CONCLUSIONS
Depression was associated with significantly worsened survival regardless of time of diagnosis, especially among patients with high-grade glioma.
引言
目前对于抑郁症对胶质瘤患者生存的影响，尚未形成完善的共识。更深入地了解这些影响，可能会更好地凸显识别该患者群体中抑郁症状的重要性，并为未来的治疗方案提供指导。
目的
本荟萃分析旨在研究抑郁症对胶质瘤患者生存的影响。
方法
根据PRISMA指南进行荟萃分析。检索了PubMed、Embase和Cochrane数据库，以查找截至2016年11月6日报告胶质瘤患者抑郁与生存情况的研究。采用随机效应（RE）模型和固定效应（FE）模型，比较有抑郁症和无抑郁症的胶质瘤患者的生存结局。
结果
在619篇已识别的文章中，6篇被选入荟萃分析。使用RE模型，与无抑郁症的患者相比，患有抑郁症的高低级别胶质瘤患者的各种生存结局指标均显示较差。对于二元生存结局，高级别胶质瘤（HGG）的总体合并生存风险比为0.70（95%CI：0.47，1.04；6项研究；I=54.9%，P异质性=0.05），低级别胶质瘤（LGG）为0.28（95%CI：0.04，1.78；I=0%，P异质性=1.00；1项研究）。HGG组按抑郁时间（术前与术后）进行的亚组分析显示，抑郁与生存结局之间无差异（P交互作用=0.47）。对于连续生存结局，高低级别胶质瘤组之间未发现统计学显著差异（P交互作用=0.31）。HGG的生存结局标准化平均差（SMD）为-0.56个月（95%CI：-1.13，0.02；4项研究，I=89.4%，P异质性<0.01），LGG为-1.69个月（95%CI：-3.26，-0.13；1项研究；I=0%，P异质性=1.00）。在HGG患者中，抑郁患者的合并死亡风险比也显示出死亡风险有临界显著增加（HR 1.42，95%CI：1.00, 2.01）。使用FE模型的结果没有实质性差异。
结论
无论诊断时间如何，抑郁症都与生存显著恶化相关，尤其是在高级别胶质瘤患者中。
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