Department of Operating Room, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China.
Department of Ultrasonography, The 2nd Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, Harbin 150001, China.
Clin Res Hepatol Gastroenterol. 2021 Jul;45(4):101511. doi: 10.1016/j.clinre.2020.07.016. Epub 2021 Mar 11.
This study was to investigate the longitudinal change of post-operative anxiety and depression, their related risk factors and prognostic value in colorectal cancer (CRC) patients after resection.
Totally, 302 CRC patients who underwent resection were consecutively recruited. Their anxiety and depression were assessed by hospital anxiety and depression scale (HADS) at Month 0 (M0) and then every 3 months till Month 36 (M36).
Within 36-month follow-up period, HADS-A score (from 8.3 ± 3.3 at M0 to 8.8 ± 3.4 at M36, P = 0.179) exhibited an upward trend with time but without statistical significance; while anxiety rate (from 46.4% at M0 to 52.6% at M36, P = 0.019) was increased steadily with time longitudinally. Meanwhile, both HADS-D score (from 7.4±3.0 at M0 to 9.2±3.5 at M36, P < 0.001) and depression rate (from 33.8% at M0 to 57.9% at M36, P < 0.001) were elevated greatly with time longitudinally. Furthermore, multivariate logistic regression revealed that female and tumor size (≥5 cm) were common independent risk factors for baseline/1-year/2-year/3-year anxiety (all P < 0.05); meanwhile, female, marry status (single/divorced/widowed vs. married) and advanced TNM stage were common independent risk factors for baseline/1-year/2-year/3-year depression (all P < 0.05). As for new-onset anxiety and depression, no independent factor associated with new-onset anxiety was observed; meanwhile, female and TNM stage were independent risk factors for new-onset depression (both P < 0.05). Additionally, baseline/1-year anxiety and baseline/1-year/2-year/3-year depression were associated with lower accumulating OS (all P < 0.05).
Post-operative anxiety and depression are highly prevalent and continuously progress, which also correlate with worse survival prognosis in CRC patients.
本研究旨在探讨结直肠癌（CRC）患者术后焦虑和抑郁的纵向变化及其相关危险因素和预后价值。
连续招募了 302 例接受切除术的 CRC 患者。在 M0 时（术后第 0 个月）以及随后每 3 个月进行 HADS 评估，直至 M36（术后第 36 个月）。
在 36 个月的随访期间，HADS-A 评分（从 M0 的 8.3±3.3 升高至 M36 的 8.8±3.4，但无统计学意义，P=0.179）呈上升趋势，但无统计学意义；而焦虑发生率（从 M0 的 46.4%升高至 M36 的 52.6%，P=0.019）则呈稳步上升趋势。同时，HADS-D 评分（从 M0 的 7.4±3.0 升高至 M36 的 9.2±3.5，P<0.001）和抑郁发生率（从 M0 的 33.8%升高至 M36 的 57.9%，P<0.001）也呈显著升高趋势。此外，多变量 logistic 回归显示，女性和肿瘤大小（≥5cm）是基线/1 年/2 年/3 年焦虑的常见独立危险因素（均 P<0.05）；同时，女性、婚姻状况（单身/离婚/丧偶与已婚）和晚期 TNM 分期是基线/1 年/2 年/3 年抑郁的常见独立危险因素（均 P<0.05）。至于新发焦虑和抑郁，没有与新发焦虑相关的独立因素；而女性和 TNM 分期是新发抑郁的独立危险因素（均 P<0.05）。此外，基线/1 年焦虑和基线/1 年/2 年/3 年抑郁与较低的累计 OS 相关（均 P<0.05）。
术后焦虑和抑郁发生率较高且呈持续进展趋势，与 CRC 患者的生存预后较差相关。
