Wang Gang, Pan Shengjie
Department of General Surgery, The First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou City, Jiangsu Province, China.
Department of Neurology, The First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou City, Jiangsu Province, China.
Ann Surg Oncol. 2025 Sep;32(9):6858-6876. doi: 10.1245/s10434-025-17675-1. Epub 2025 Jul 2.
Postoperative gastric cancer patients often experience psychologic distress, sleep disturbances, and impaired immune function, negatively impacting long-term prognosis. This study evaluated the effects of a combined psychological intervention and sleep enhancement program on mental health, sleep quality, immune function, inflammation, and survival outcomes.
This prospective, single-blind, randomized controlled trial involved 198 patients who underwent radical gastrectomy. The patients were randomly assigned to either the intervention group (n = 99) or the control group (n = 99). The primary endpoints were psychological well-being and immune function, evaluated by changes in Hospital Anxiety and Depression Scale (HADS) scores and the CD4⁺/CD8⁺ T cell ratio at 3 months. The secondary outcomes were the Pittsburgh Sleep Quality Index (PSQI), inflammatory markers, and long-term oncologic outcomes, including the tumor recurrence rate (TRR), 2-year disease-free survival (DFS), and overall survival (OS). The intervention group participated in a 12-week structured program combining cognitive behavioral therapy (CBT), psychological counseling, sleep hygiene education, melatonin supplementation, and sleep behavior training.
At 3 months, the intervention group showed significant reductions in anxiety (HADS-A, 12.3 → 7.1; P < 0.01), depression (HADS-D, 11.8 → 6.5; P < 0.01), and perceived stress (Perceived Stress Scale [PSS], 21.4 → 14.2; P < 0.01). Sleep quality improved (PSQI, 10.5 → 6.2; P < 0.001), with enhanced immune function (CD4⁺/CD8⁺ ratio, 1.78 → 1.44; P = 0.001) and decreased inflammatory markers (interleukin 6 [IL-6], 12.4 → 8.2 pg/mL [P = 0.001]; tumor necrosis factor alpha [TNFα], 9.3 → 6.1 pg/mL [P = 0.003]). The DFS rate (81.2 % vs. 68.5 %; P = 0.005), OS rate (88.5 % vs. 76.7 %; P = 0.003), and TRR (18.8 % vs. 31.5 %; P = 0.006) were significantly improved.
The combined psychological and sleep intervention effectively reduced anxiety, depression, and stress; enhanced sleep quality; boosted immune function; reduced inflammation; and improved survival outcomes in gastric cancer patients.
胃癌术后患者常出现心理困扰、睡眠障碍和免疫功能受损，对长期预后产生负面影响。本研究评估了心理干预与睡眠改善计划相结合对心理健康、睡眠质量、免疫功能、炎症和生存结局的影响。
这项前瞻性、单盲、随机对照试验纳入了198例行根治性胃切除术的患者。患者被随机分为干预组（n = 99）和对照组（n = 99）。主要终点为心理健康和免疫功能，通过3个月时医院焦虑抑郁量表（HADS）评分变化和CD4⁺/CD8⁺ T细胞比值进行评估。次要结局包括匹兹堡睡眠质量指数（PSQI）、炎症标志物和长期肿瘤学结局，包括肿瘤复发率（TRR）、2年无病生存率（DFS）和总生存率（OS）。干预组参加了一个为期12周的结构化计划，该计划结合了认知行为疗法（CBT）、心理咨询、睡眠卫生教育、褪黑素补充和睡眠行为训练。
3个月时，干预组的焦虑（HADS - A，12.3 → 7.1；P < 0.01）、抑郁（HADS - D，11.8 → 6.5；P < 0.01）和感知压力（感知压力量表[PSS]，21.4 → 14.2；P < 0.01）显著降低。睡眠质量改善（PSQI，10.5 → 6.2；P < 0.001），免疫功能增强（CD4⁺/CD8⁺比值，1.78 → 1.44；P = 0.001），炎症标志物降低（白细胞介素6 [IL - 6]，12.4 → 8.2 pg/mL [P = 0.001]；肿瘤坏死因子α [TNFα]，9.3 → 6.1 pg/mL [P = 0.003]）。DFS率（81.2%对68.5%；P = 0.005）、OS率（88.5%对76.7%；P = 0.003）和TRR（18.8%对31.5%；P = 0.006）均显著改善。
心理和睡眠联合干预有效降低了胃癌患者的焦虑、抑郁和压力；提高了睡眠质量；增强了免疫功能；减轻了炎症；并改善了生存结局。
