Huntsman Cancer Institute, Salt Lake City, Utah.
Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany.
Cancer Epidemiol Biomarkers Prev. 2023 Mar 6;32(3):363-370. doi: 10.1158/1055-9965.EPI-22-0882.
Patients with colorectal cancer commonly suffer from complex psychological distress. Elevated distress may be linked to systemic biomarkers. We investigated associations of biomarkers of inflammation and angiogenesis with cancer-related distress (CTXD) score.
N = 315 patients (stage I-IV) from 2 centers of the ColoCare Study were included: Huntsman Cancer Institute and University of Heidelberg. Biomarkers (e.g., IL6, VEGF-A, VEGF-D) were measured in serum collected pre-surgery and 12 months thereafter. The CTXD overall score and 4 subscales were collected 12 months after surgery and dichotomized to investigate biomarkers as predictors of distress 12 months after surgery; adjusted for age, sex, body mass index, tumor stage, center, and baseline levels of biomarkers.
Doubling of IL6 predicted future increased risk of overall distress [odds ratio (OR), 1.20; 95% confidence interval (CI), 1.02-1.41; P = 0.03]. VEGF-A-predicted future increased risk of high family strain (VEGF-A: OR, 1.21; 95% CI, 1.01-1.44; P = 0.04) and VEGF-D was associated with medical and financial demands (OR, 1.34; 95% CI, 1.01-1.74; P = 0.03).
This is the first study to show that systemic biomarkers are significantly associated with future CTXD score. Distress was not measured at baseline; we cannot rule out ongoing associations of inflammation and distress throughout treatment versus a direct effect of inflammation on distress. Nonetheless, these data add to evidence that biobehavioral processes interact and that systemic biomarkers are associated with cancer-related distress one year after surgery.
Exercise and diet interventions that lower systemic cytokine levels may impact longer-term CTXD score and improve quality of life of patients with colorectal cancer.
结直肠癌患者常伴有复杂的心理困扰。心理困扰的增加可能与系统性生物标志物有关。我们研究了炎症和血管生成生物标志物与癌症相关的困扰（CTXD）评分之间的关联。
共纳入来自 ColoCare 研究的 2 个中心（亨斯迈癌症研究所和海德堡大学）的 315 例患者（I-IV 期）：术前和术后 12 个月采集血清样本，测量生物标志物（如 IL6、VEGF-A、VEGF-D）。术后 12 个月采集 CTXD 总分和 4 个亚量表，并将其分为 2 组，以研究术后 12 个月生物标志物作为困扰的预测因子；调整年龄、性别、体重指数、肿瘤分期、中心和生物标志物基线水平。
IL6 加倍预示着未来整体困扰的风险增加[优势比（OR），1.20；95%置信区间（CI），1.02-1.41；P=0.03]。VEGF-A 预示着未来家庭负担加重的风险增加（VEGF-A：OR，1.21；95%CI，1.01-1.44；P=0.04），VEGF-D 与医疗和经济需求相关（OR，1.34；95%CI，1.01-1.74；P=0.03）。
这是第一项表明系统性生物标志物与未来 CTXD 评分显著相关的研究。困扰不是在基线时测量的；我们不能排除炎症和困扰在整个治疗过程中的持续关联，也不能排除炎症对困扰的直接影响。尽管如此，这些数据进一步证明了生物行为过程相互作用，以及系统性生物标志物与术后 1 年的癌症相关困扰相关。
降低系统性细胞因子水平的运动和饮食干预可能会影响长期的 CTXD 评分，并改善结直肠癌患者的生活质量。
