Otto-Meyer Sebastian, DeFaccio Rian, Dussold Corey, Ladomersky Erik, Zhai Lijie, Lauing Kristen L, Bollu Lakshmi R, Amidei Christina, Lukas Rimas V, Scholtens Denise M, Wainwright Derek A
Department of Neurological Surgery, Chicago, IL, 60611, USA.
Department of Preventative Medicine-Biostatistics, Chicago, IL, 60611, USA.
Brain Behav Immun Health. 2020 Feb;2. doi: 10.1016/j.bbih.2019.100025. Epub 2019 Dec 16.
Glioblastoma (GBM) is the most common and aggressive form of malignant glioma in adults with a median overall survival (OS) time of 16-18 months and a median age of diagnosis at 64 years old. Recent work has suggested that depression and psychosocial distress are associated with worse outcomes in patients with GBM. We therefore hypothesized that the targeted neutralization of psychosocial distress with selective serotonin reuptake inhibitor (SSRI) antidepressant treatment would be associated with a longer OS among patients with GBM. To address this hypothesis, we retrospectively studied the association between adjuvant SSRI usage and OS in GBM patients treated by Northwestern Medicine-affiliated providers. The medical records of 497 GBM patients were analyzed after extraction from the Northwestern Medicine Enterprise Data Warehouse. Data were retrospectively studied using a multivariable Cox model with SSRI use defined as a time-dependent variable for estimating the association with OS. Of the 497 patients, 315 individuals died, while 182 were censored due to the loss of follow-up or were alive at the end of our study. Of the 497 patients, 151 had a recorded use of SSRI treatment during the disease course. Unexpectedly, SSRI usage was not associated with an OS effect in both naïve (HR = 0.81, 95% CI = 0.64-1.03) and adjusted time-dependent (HR = 1.26, 95% CI = 0.97-1.63) Cox models. Ultimately, we failed to find an association between SSRI treatment and an improved OS of patients with GBM. Additional work is necessary for understanding the potential therapeutic effects of SSRIs when combined with other treatment approaches, and immunotherapies in particular, for subjects with GBM.
胶质母细胞瘤（GBM）是成人中最常见且侵袭性最强的恶性胶质瘤形式，总体生存期（OS）中位数为16 - 18个月，诊断时的中位年龄为64岁。最近的研究表明，抑郁症和心理社会困扰与GBM患者的不良预后相关。因此，我们假设用选择性5-羟色胺再摄取抑制剂（SSRI）抗抑郁治疗针对性地消除心理社会困扰，将与GBM患者更长的OS相关。为验证这一假设，我们回顾性研究了西北医学附属机构治疗的GBM患者中辅助使用SSRI与OS之间的关联。从西北医学企业数据仓库提取了497例GBM患者的病历并进行分析。使用多变量Cox模型对数据进行回顾性研究，将SSRI的使用定义为时间依赖性变量，以估计与OS的关联。497例患者中，315人死亡，182人因失访被 censored或在研究结束时仍存活。497例患者中，151例在病程中有SSRI治疗记录。出乎意料的是，在未调整（HR = 0.81，95% CI = 0.64 - 1.03）和调整后的时间依赖性（HR = 1.26，95% CI = 0.97 - 1.63）Cox模型中，SSRI的使用均与OS效应无关。最终，我们未能发现SSRI治疗与GBM患者OS改善之间的关联。对于理解SSRI与其他治疗方法（特别是免疫疗法）联合使用时对GBM患者的潜在治疗效果，还需要进一步研究。
