Sun Yifei, Hamo Mohammad, Atchley Travis, Markert James M, Nabors Burt, Estevez-Ordonez Dagoberto
Res Sq. 2025 Aug 19:rs.3.rs-7339610. doi: 10.21203/rs.3.rs-7339610/v1.
Glioblastoma is the most common primary brain malignancy and carries significant mortality. Preclinical studies have highlighted the efficacy of antidepressant therapy in inhibiting glioblastoma progression; however, real-world evidence remains conflicting. We sought to investigate the impact of different commonly utilized antidepressant therapies on survival in patients with glioblastoma. In total, 1464 consecutive patients with glioblastoma treated at a single institution from 2008 to 2023 were included for analysis. Multivariate cox regression analysis with antidepressant usage modeled as a time varying covariate was used to assess the effect of antidepressants while controlling for a priori selected clinical variables with known relevance to survival. The median age at diagnosis was 62 (IQR 52-70) years with a median overall survival of 13.8 months. Of the cohort, 44% utilized antidepressants after diagnosis, with SSRIs as the most common class utilized (26%). The median duration of any antidepressant therapy was 111 (IQR 9-303) days. In a time varying, multivariate cox regression, usage of SSRIs (HR 1.4, 95%CI 1.21-1.62), SNRIs (HR 1.33, 95%CI 1.03-1.72), serotonin modulators (HR 1.61, 95%CI 1.40-1.86), and atypical antidepressants (HR 1.7, 95%CI 1.28-2.26) were associated with worse survival. Amongst SSRIs, only escitalopram (HR 1.33, 95%CI 1.10-1.60) and citalopram (HR 1.31, 95%CI 1.01-1.70) were associated with worse survival. SSRIs, SNRIs, serotonin modulators, and atypical antidepressants are associated with worse survival in patients with glioblastoma. Careful selection of antidepressant medication in patients with glioblastoma may be necessary to optimize outcomes.
胶质母细胞瘤是最常见的原发性脑恶性肿瘤，死亡率很高。临床前研究强调了抗抑郁治疗在抑制胶质母细胞瘤进展方面的疗效；然而，实际证据仍然存在矛盾。我们试图研究不同常用抗抑郁治疗对胶质母细胞瘤患者生存的影响。总共纳入了2008年至2023年在单一机构接受治疗的1464例连续胶质母细胞瘤患者进行分析。以抗抑郁药物使用作为时间变化协变量的多变量Cox回归分析用于评估抗抑郁药物的效果，同时控制预先选择的与生存相关的临床变量。诊断时的中位年龄为62岁（四分位间距52 - 70岁），中位总生存期为13.8个月。在该队列中，44%的患者在诊断后使用了抗抑郁药物，其中选择性5-羟色胺再摄取抑制剂（SSRI）是最常用的类别（26%）。任何抗抑郁治疗的中位持续时间为111天（四分位间距9 - 303天）。在时间变化的多变量Cox回归中，使用SSRI（风险比1.4，95%置信区间1.21 - 1.62）、5-羟色胺去甲肾上腺素再摄取抑制剂（SNRI）（风险比1.33，95%置信区间1.03 - 1.72）、5-羟色胺调节剂（风险比1.61，95%置信区间1.40 - 1.86）和非典型抗抑郁药（风险比1.7，95%置信区间1.28 - 2.26）与较差的生存率相关。在SSRI中，只有艾司西酞普兰（风险比1.33，95%置信区间1.10 - 1.60）和西酞普兰（风险比1.31，95%置信区间1.01 - 1.70）与较差的生存率相关。SSRI、SNRI、5-羟色胺调节剂和非典型抗抑郁药与胶质母细胞瘤患者较差的生存率相关。为了优化治疗结果，可能需要在胶质母细胞瘤患者中谨慎选择抗抑郁药物。
