National Central Cancer Registry, National Cancer Center / National Clinical Research Center for Cancer / Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, 100101, China.
BMC Psychiatry. 2021 Nov 10;21(1):554. doi: 10.1186/s12888-021-03534-2.
Esophageal cancer (EC) is one of the leading contributors to the global burden of cancer, and the underlying mechanism is still unknown. Recently, there has been a growing interest in understanding modifiable psychosocial risk factors, particularly depression, to prevent EC and reduce morbidity and mortality. However, related research is sparse and has been ignored. The study was designed to assess the association between depression and EC in China.
From 2017 to 2019, a population-based multicenter study was conducted in high-risk regions of EC. Participants underwent a free endoscopy screening. If the endoscopic results were suspicious, a pathological biopsy was applied to confirm. Depression was measured with Patient Health Questionnaire-9 (PHQ-9). In addition, information on demographic characteristics and risk factors was collected from participants by trained interviewers using uniform questionnaires.
After Endoscopy and pathologic diagnosis, 15,936 participants in high-risk regions of EC (ECHRRs) were enrolled, 10,907 (68.44%) of which were diagnosed health, 4048 (25.40%) with esophagitis, 769 (4.83%) with low-grade intraepithelial neoplasia (LGIN), 157 (0.99%) with high-grade intraepithelial neoplasia (HGIN), and 55 (0.35%) with EC, respectively. The overall prevalence of depression symptoms of participants was 4.16% (health: 4.63%, esophagitis: 2.99%, LGIN: 2.99%, HGIN: 5.73%, and EC: 9.09%). Multiple logistic regression analyses revealed that the unadjusted OR (95% CI) between depression and each esophageal pathology grades were esophagitis 0.93 (0.92-0.95), LGIN 0.97 (0.94-0.99), HGIN 1.05 (1.00-1.10), and EC 1.04 (0.97-1.14), respectively. However, after adjustment for potential confounders (age, gender, region, alcohol consumption, BMI), no statistically significant associations between depression and EC (adjusted OR = 1.10, 0.99-1.21) and esophageal lesions (esophagitis: adjusted OR = 1.02, 0.99-1.04; LGIN: adjusted OR = 0.98, 0.95-1.01; HGIN: adjusted OR = 1.04, 0.98-1.11) were observed in this study.
No significant association was observed between depression and EC in the study. Future prospective cohort studies are needed to verify this preliminary finding.
食管癌（EC）是导致全球癌症负担的主要原因之一，但其潜在机制尚不清楚。最近，人们越来越关注了解可改变的心理社会危险因素，特别是抑郁症，以预防 EC 并降低发病率和死亡率。然而，相关研究很少，且被忽视了。本研究旨在评估中国抑郁症与 EC 之间的关联。
本研究于 2017 年至 2019 年在 EC 高危地区进行了一项基于人群的多中心研究。参与者接受免费内镜筛查。如果内镜检查结果可疑，则应用病理活检进行确认。使用患者健康问卷-9（PHQ-9）评估抑郁症。此外，通过培训过的调查员使用统一的问卷，从参与者那里收集人口统计学特征和危险因素信息。
在接受内镜和病理诊断后，共纳入 15936 名 EC 高危地区（ECHRRs）参与者，其中 10907 名（68.44%）被诊断为健康，4048 名（25.40%）患有食管炎，769 名（4.83%）患有低级别上皮内瘤变（LGIN），157 名（0.99%）患有高级别上皮内瘤变（HGIN），55 名（0.35%）患有 EC。参与者中抑郁症症状的总体患病率为 4.16%（健康：4.63%，食管炎：2.99%，LGIN：2.99%，HGIN：5.73%，EC：9.09%）。多因素逻辑回归分析显示，抑郁症与每个食管病理分级之间的未调整比值比（95%CI）分别为食管炎 0.93（0.92-0.95）、LGIN 0.97（0.94-0.99）、HGIN 1.05（1.00-1.10）和 EC 1.04（0.97-1.14）。然而，在调整了潜在混杂因素（年龄、性别、地区、饮酒、BMI）后，抑郁症与 EC（调整后 OR=1.10，0.99-1.21）和食管病变（食管炎：调整后 OR=1.02，0.99-1.04；LGIN：调整后 OR=0.98，0.95-1.01；HGIN：调整后 OR=1.04，0.98-1.11）之间无统计学显著关联。
本研究未观察到抑郁症与 EC 之间存在显著关联。需要进一步的前瞻性队列研究来验证这一初步发现。
