Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nantou, Taiwan.
Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan.
JAMA Netw Open. 2023 Sep 5;6(9):e2332579. doi: 10.1001/jamanetworkopen.2023.32579.
Liver cancer, primarily hepatocellular carcinoma (HCC), is the third leading cause of cancer deaths worldwide. Although some studies have proposed that antidepressants may have apoptotic effects on cancer, no study has examined the association between antidepressant use and HCC prognosis.
To investigate the association between antidepressant use and mortality risk in patients with HCC.
DESIGN, SETTING, AND PARTICIPANTS: This population-based cohort study analyzed Taiwan's National Health Insurance Research Database, which covers 99% of Taiwan's population and includes comprehensive medical information. Patients with a new diagnosis of HCC between 1999 and 2017 were identified. Analysis took place in June 2023.
All patients with HCC were followed up until 2018 to measure overall and cancer-specific mortality. To examine whether the timing of antidepressant use influenced the association with mortality, antidepressant use was examined before and after HCC diagnosis. Cox proportional hazards regression was performed to estimate hazard ratios (HRs) and the 95% CIs for the association between antidepressant use and overall mortality and cancer-specific mortality.
The study cohort comprised 308 938 participants, primarily consisting of older individuals (131 991 [42.7%] were aged ≥65 years) with a higher proportion of male individuals (202 589 [65.6%]). Antidepressant use before the diagnosis of HCC was not associated with lower risks of overall mortality (adjusted HR, 1.10; 95% CI, 1.08-1.12) and cancer-specific mortality (adjusted HR, 1.06; 95% CI, 0.96-1.17). However, antidepressant use after a diagnosis of HCC was associated with a lower risk of overall mortality (adjusted HR, 0.69; 95% CI, 0.68-0.70) and cancer-specific mortality (adjusted HR, 0.63; 95% CI, 0.59-0.68). The observed associations were consistent across subgroups with different antidepressant classes and comorbidities, including hepatitis B virus or hepatitis C virus infection, liver cirrhosis, and alcohol use disorders.
Based on this nationwide cohort study, postdiagnosis antidepressant use may be associated with lower mortality in patients with HCC. Further randomized clinical trial evaluation should be considered.
肝癌，主要是肝细胞癌（HCC），是全球癌症死亡的第三大主要原因。尽管一些研究提出抗抑郁药可能对癌症具有凋亡作用，但没有研究探讨抗抑郁药使用与 HCC 预后之间的关系。
调查抗抑郁药使用与 HCC 患者死亡风险之间的关联。
设计、地点和参与者：这项基于人群的队列研究分析了台湾的全民健康保险研究数据库，该数据库涵盖了台湾 99%的人口，并包含了全面的医疗信息。研究纳入了 1999 年至 2017 年间新诊断为 HCC 的患者。分析于 2023 年 6 月进行。
所有 HCC 患者均随访至 2018 年，以测量总死亡率和癌症特异性死亡率。为了研究抗抑郁药使用时机是否影响与死亡率的关联，研究考察了 HCC 诊断前后的抗抑郁药使用情况。使用 Cox 比例风险回归估计了抗抑郁药使用与总死亡率和癌症特异性死亡率之间的关联的风险比（HR）和 95%置信区间（CI）。
研究队列包括 308938 名参与者，主要由老年人（131991 名[42.7%]年龄≥65 岁）组成，且男性比例较高（202589 名[65.6%]）。HCC 诊断前使用抗抑郁药与总死亡率（校正 HR，1.10；95%CI，1.08-1.12）和癌症特异性死亡率（校正 HR，1.06；95%CI，0.96-1.17）降低无关。然而，HCC 诊断后使用抗抑郁药与总死亡率（校正 HR，0.69；95%CI，0.68-0.70）和癌症特异性死亡率（校正 HR，0.63；95%CI，0.59-0.68）降低相关。在不同抗抑郁药类别和合并症（包括乙型肝炎病毒或丙型肝炎病毒感染、肝硬化和酒精使用障碍）的亚组中，观察到的关联是一致的。
基于这项全国性队列研究，HCC 患者诊断后使用抗抑郁药可能与死亡率降低相关。应考虑进一步进行随机临床试验评估。
