抗抑郁药与胶质瘤患者的生存——一项基于登记处的回顾性队列研究
Antidepressants and survival in glioma-A registry-based retrospective cohort study.
作者信息
Edström Sonja, Hellquist Barbro Numan, Sandström Maria, Sadanandan Sajna Anand, Björkblom Benny, Melin Beatrice, Sjöberg Rickard L
机构信息
Department of Clinical Sciences, Neurosciences, Umeå University, Umeå, Sweden.
Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden.
出版信息
Neurooncol Pract. 2023 Aug 30;11(2):125-131. doi: 10.1093/nop/npad057. eCollection 2024 Apr.
BACKGROUND
Depression and treatment with antidepressant medication is common in patients with malignant glioma. However, the extent to which antidepressants may affect the disease is not fully understood. Therefore, the purpose of the present study was to investigate possible associations between treatment with antidepressant medication and survival in glioma patients.
METHODS
We performed a registry-based cohort study including 1231 patients with malignant glioma (WHO grades 2, 3, and 4) having undergone surgery, and 6400 matched controls without glioma. All data were extracted from the RISK North database, which contains information from multiple national population-based registries in Sweden.
RESULTS
Treatment with antidepressants is more common in patients with malignant glioma (27%), compared to controls (16%), < .001. Treatment with antidepressants after surgery for glioma was significantly associated with poorer survival. These effects were observed both for selective serotonin reuptake inhibitors (SSRIs) and non-SSRIs. In grade 4 glioma, SSRI treatment was associated with a hazard ratio (HR) of 3.32 (95% CI 2.69-4.10, < .001), and non-SSRI treatment a HR of 3.54 (95% CI 2.52-4.99, < .001), compared to glioma patients without antidepressants. In grade 2-3 glioma, the HR for SSRI treatment was 3.26 (95% CI 2.19-4.85, < .001), and for non-SSRI treatment was 7.71 (95% CI 4.22-14.12, < .001).
CONCLUSIONS
Our results demonstrate a negative association between antidepressant medication and survival in glioma. Further research will be needed to clarify causation.
背景
抑郁症及抗抑郁药物治疗在恶性胶质瘤患者中很常见。然而，抗抑郁药对该疾病的影响程度尚未完全明确。因此，本研究的目的是调查抗抑郁药物治疗与胶质瘤患者生存率之间的可能关联。
方法
我们进行了一项基于登记处的队列研究，纳入了1231例接受过手术的恶性胶质瘤患者（世界卫生组织2、3、4级），以及6400例匹配的无胶质瘤对照。所有数据均从RISK North数据库中提取，该数据库包含来自瑞典多个全国性人群登记处的信息。
结果
与对照组（16%）相比，恶性胶质瘤患者中使用抗抑郁药治疗更为常见（27%），P<0.001。胶质瘤手术后使用抗抑郁药治疗与较差的生存率显著相关。选择性5-羟色胺再摄取抑制剂（SSRI）和非SSRI均观察到这些效应。在4级胶质瘤中，与未使用抗抑郁药的胶质瘤患者相比，SSRI治疗的风险比（HR）为3.32（95%CI 2.69-4.10，P<0.001），非SSRI治疗的HR为3.54（95%CI 2.52-4.99，P<0.001）。在2-3级胶质瘤中，SSRI治疗的HR为3.26（95%CI 2.19-4.85，P<0.001），非SSRI治疗的HR为7.71（95%CI 4.22-14.12，P<0.001）。
结论
我们的结果表明抗抑郁药物与胶质瘤患者的生存率之间存在负相关。需要进一步研究以阐明因果关系。
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