Department of Psychiatry, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 10, 63-ro, Yeongdeungpo-gu, Seoul, Republic of Korea.
Department of Hematology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Sci Rep. 2020 Sep 17;10(1):15265. doi: 10.1038/s41598-020-71208-2.
Studies investigating association of depression with overall survival (OS) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) yielded conflicting results. A nationwide cohort study, which included all adult patients [n = 7,170; depression group, 13.3% (N = 956); non-depression group, 86.7% (N = 6,214)] who received allo-HSCT from 2002 to 2018 in South Korea, analyzed risk of pre-transplant depression in OS of allo-HSCT. Subjects were followed from the day they received allo-HSCT, to occurrence of death, or last follow-up day (December 31, 2018). Median age at allo-HSCT for depression and non-depression groups were 50 and 45 (p < 0.0001), respectively. Two groups also differed in rate of females (depression group, 55.8%; non-depression group, 43.8%; p < 0.0001) and leukemia (depression group, 61.4%; non-depression group, 49.7%; p < 0.0001). After a median follow-up of 29.1 months, 5-year OS rate was 63.1%. Cox proportional-hazard regression evaluated an adjusted risk of post-transplant mortality related to depression: OS decreased sequentially from no depression (adjusted hazard ratio [aHR] = 1) to pre-transplant depression only (aHR = 1.167, CI: 1.007-1.352, p = 0.04), and to having both depression and anxiety disorder (aHR = 1.202, CI: 1.038-1.393, p = 0.014) groups. Pre-transplant anxiety (anxiety only) did not have significant influence in OS. Additional medical and psychiatric care might be necessary in patients who experienced depression, especially with anxiety, before allo-HSCT.
研究表明，在异基因造血干细胞移植（allo-HSCT）后，抑郁与总生存率（OS）之间存在关联，但结果存在争议。本项全国性队列研究纳入了 2002 年至 2018 年期间在韩国接受 allo-HSCT 的所有成年患者[n=7170；抑郁组，13.3%（N=956）；非抑郁组，86.7%（N=6214）]，分析了移植前抑郁对 allo-HSCT 患者 OS 的影响。研究对象从接受 allo-HSCT 之日起开始随访，直至死亡或最后一次随访日（2018 年 12 月 31 日）。抑郁组和非抑郁组 allo-HSCT 时的中位年龄分别为 50 岁和 45 岁（p<0.0001）。两组在女性比例（抑郁组 55.8%，非抑郁组 43.8%；p<0.0001）和白血病比例（抑郁组 61.4%，非抑郁组 49.7%；p<0.0001）上也存在差异。中位随访 29.1 个月后，5 年 OS 率为 63.1%。Cox 比例风险回归评估了移植后抑郁与死亡相关的调整后死亡风险：OS 依次从无抑郁（调整后风险比[aHR]=1）下降到仅存在移植前抑郁（aHR=1.167，95%CI：1.007-1.352，p=0.04），再到同时存在抑郁和焦虑障碍（aHR=1.202，95%CI：1.038-1.393，p=0.014）。移植前焦虑（仅有焦虑）对 OS 没有显著影响。在 allo-HSCT 之前经历过抑郁，特别是伴有焦虑的患者，可能需要额外的医疗和精神科护理。
