Chen Feng-Xia, Chen Xian-Shan, Guo Jun-Cheng, Zheng Bao-Ai, Guo Min
Department of Thoracic Surgery, Hainan People's Hospital Haikou 570311, Hainan Province, P. R. China.
Hainan General Hospital Haikou 570311, Hainan Province, P. R. China.
Int J Clin Exp Pathol. 2019 Mar 1;12(3):968-977. eCollection 2019.
The serotonin-transporter-linked polymorphic region (5-HTTLPR) gene has been reported to predispose individuals experiencing trauma to affective disorders such as anxiety and depression. We hypothesized that SS genotype of 5-HTTLPR gene would induce stress conditions and poor prognosis of papillary thyroid carcinoma (PTC). The study enrolled 287 patients with or without post-traumatic stress disorder (PTSD) following surgical treatment of PTC with their baseline characteristics collected. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was conducted to detect genotype frequency. Five self-rating scales, including Impact of Event Scale-Revised Edition (IES-R), MedicaI Coping Modes Questionnaire (MCMO), Hamilton Depression Scale (HAMD), Social Support Rating Scale (SSRS) and Stressful Life Events (SLEs), were used for depressive state assessment. Survival situations were observed through 15-year follow-up visits one time every six months. Survival rate was calculated using Life Table. Logistic regression analysis was used to analyze factors related to prognosis of PTC. Increased SS genotype and decreased LL genotypes were found in patients with PTSD. PTSD is associated with high stress, and inter-group analysis revealed that patients carrying SS genotype exhibited a high stress condition. PTSD and SS genotype correlated to large tumor size, advanced clinical stage, lymph node metastasis, and decreased 10-year and 15-year survival rate. As for patients carrying the same genotype, those suffering from PTSD showed poorer survival. Also, 5-HTTPRL, MCMQ score (confrontation/avoidance/surrender), HAMD score, SSRS total score, SLEs score, tumor size, clinical stage, and lymph node metastasis were relevant factors for prognosis of PTC. The results demonstrate SS genotype of the 5-HTTPRL gene as a contributor of high stress among patients with PTC. Thus, 5-HTTPRL and stress conditions represent potential investigative focus targets for prognosis of PTC.
血清素转运体相关多态性区域（5-HTTLPR）基因据报道会使经历创伤的个体易患焦虑和抑郁等情感障碍。我们假设5-HTTLPR基因的SS基因型会诱发应激状况并导致甲状腺乳头状癌（PTC）预后不良。该研究纳入了287例接受PTC手术治疗的患者，无论其有无创伤后应激障碍（PTSD），并收集了他们的基线特征。采用聚合酶链反应-限制性片段长度多态性（PCR-RFLP）检测基因型频率。使用五个自评量表，包括事件影响量表修订版（IES-R）、医学应对方式问卷（MCMQ）、汉密尔顿抑郁量表（HAMD）、社会支持评定量表（SSRS）和生活应激事件（SLEs），进行抑郁状态评估。通过每六个月进行一次的15年随访观察生存情况。使用寿命表计算生存率。采用逻辑回归分析分析与PTC预后相关的因素。在患有PTSD的患者中发现SS基因型增加而LL基因型减少。PTSD与高应激相关，组间分析显示携带SS基因型的患者表现出高应激状况。PTSD和SS基因型与肿瘤体积大、临床分期晚、淋巴结转移以及10年和15年生存率降低相关。对于携带相同基因型的患者，患有PTSD的患者生存情况较差。此外，5-HTTPRL、MCMQ评分（面对/回避/屈服）、HAMD评分、SSRS总分、SLEs评分、肿瘤大小、临床分期和淋巴结转移是PTC预后的相关因素。结果表明5-HTTPRL基因的SS基因型是PTC患者高应激的一个因素。因此，5-HTTPRL和应激状况是PTC预后潜在的研究重点目标。
