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胃癌患者的抑郁:综合治疗策略及临床意义

Depression in gastric cancer patients: Integrated therapeutic strategies and clinical implications.

作者信息

Yu Pei-Yuan, Liu Feng, Jiao Yan, Zhao Yue-Chen, Liu Ya-Hui

机构信息

Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China.

Department of Oncology, Tonghua Central Hospital, Tonghua 134001, Jilin Province, China.

出版信息

World J Clin Oncol. 2025 Jun 24;16(6):106229. doi: 10.5306/wjco.v16.i6.106229.

Abstract

Depression is a common comorbidity in gastric cancer (GC) patients, with prevalence rates reaching up to 57%, particularly in advanced stages and during active treatment. While prior studies have explored the bidirectional relationship between GC and depression, this editorial provides a structured synthesis of therapeutic strategies including pharmacological, psychotherapeutic, integrative, and biomarker-driven interventions, within a multidisciplinary care framework. Depression may exacerbate tumor progression through chronic stress and neurotransmitter dysregulation, such as β2-adrenergic receptor activation, while the cancer burden deepens psychological distress. Antidepressants, especially selective serotonin reuptake inhibitors, have demonstrated efficacy in alleviating depressive symptoms in up to 70% of cases, particularly when used alongside chemotherapy. Psychotherapeutic modalities, including cognitive-behavioral therapy and family-based interventions, help reduce depressive symptoms, improve coping mechanisms, and prevent relapse. Integrative strategies like music therapy, mindfulness, and physical activity further support emotional well-being, particularly in mild-to-moderate depression. Multidisciplinary care that combines nutritional support, pain control, and psychosocial interventions is essential. Notably, the integration of interventional therapies with traditional Chinese medicine has shown potential in stabilizing tumor growth and improving mental health, enabling functional "tumor-bearing survival". Emerging immunotherapies such as cadonilimab may also contribute indirectly to depression alleviation by enhancing treatment efficacy and extending survival. Future research should focus on biomarker-guided approaches, such as targeting β2-adrenergic signaling, and developing personalized psychosocial care models. A holistic approach that integrates both physical and psychological care is vital to improving outcomes and quality of life in GC patients.

摘要

抑郁症是胃癌(GC)患者中常见的合并症,患病率高达57%,在晚期和积极治疗期间尤为突出。虽然先前的研究探讨了胃癌与抑郁症之间的双向关系,但本社论在多学科护理框架内,对包括药物、心理治疗、综合治疗和生物标志物驱动干预在内的治疗策略进行了结构化综述。抑郁症可能通过慢性应激和神经递质失调(如β2-肾上腺素能受体激活)加剧肿瘤进展,而癌症负担则会加重心理困扰。抗抑郁药,尤其是选择性5-羟色胺再摄取抑制剂,在高达70%的病例中显示出缓解抑郁症状的疗效,特别是与化疗同时使用时。心理治疗方式,包括认知行为疗法和基于家庭的干预措施,有助于减轻抑郁症状、改善应对机制并预防复发。音乐疗法、正念和体育活动等综合策略进一步支持情绪健康,特别是在轻度至中度抑郁症中。结合营养支持、疼痛控制和心理社会干预的多学科护理至关重要。值得注意的是,介入疗法与中医的结合在稳定肿瘤生长和改善心理健康方面显示出潜力,实现功能性“带瘤生存”。卡度尼利单抗等新兴免疫疗法也可能通过提高治疗效果和延长生存期间接有助于缓解抑郁症。未来的研究应侧重于生物标志物引导的方法,如靶向β2-肾上腺素能信号传导,并开发个性化的心理社会护理模式。整合身体和心理护理的整体方法对于改善胃癌患者的治疗效果和生活质量至关重要。

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