Depressive symptoms and short telomere length are associated with increased mortality in bladder cancer patients.
Depressive symptoms and short telomere length are associated with increased mortality in bladder cancer patients.
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DOI：
10.1158/1055-9965.epi-14-0992
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发表时间：
2015-02
期刊：
影响因子：
--
通讯作者：
Wu X
中科院分区：
文献类型：
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作者：
Lin J;Blalock JA;Chen M;Ye Y;Gu J;Cohen L;Cinciripini PM;Wu X
抑郁症与癌症患者死亡风险增加有关;据推测，抑郁症相关的细胞衰老机制的改变，特别是端粒/端粒酶维持系统，可能是这种风险增加的基础。我们评估了464例膀胱癌患者的抑郁症状和端粒长度与死亡率和复发/进展的关系。我们使用CES-D和SCID分别评估当前抑郁症状和终身MDD，并从外周血淋巴细胞中评估端粒长度。多变量考克斯回归分析用于评估抑郁症和端粒长度与预后的关系以及两者的联合作用。采用Kaplan-Meier曲线和对数秩检验比较抑郁变量和端粒长度亚组的生存时间。与无抑郁症状（CES-D <16）的患者相比，有抑郁症状（CES-D ≥ 16）的患者死亡风险增加1.83倍（95%CI= 1.08 - 3.08，P=0.024），无病生存期缩短（P=0.004）。同时有抑郁症状和MDD终身史的患者与两种情况均无的患者相比，风险增加4.88倍（95%CI=1.40 - 16.99; P=0.013）。与无抑郁症状且端粒长度较长的患者相比，有抑郁症状且端粒长度较短的患者的死亡风险增加4倍（HR=3.96，95%CI =1.86 ~ 8.41，P=0.0003），无病生存时间显著缩短（P<0.001）。短端粒长度和抑郁症状与膀胱癌死亡率相关。在癌症患者中，可能需要进一步研究影响抑郁和端粒长度的干预措施。
Depression is associated with an increased risk of mortality in cancer patients; it has been hypothesized that depression-associated alterations in cell aging mechanisms in particular, the telomere/telomerase maintenance system, may underlie this increased risk. We evaluated the association of depressive symptoms and telomere length to mortality and recurrence/progression in 464 bladder cancer patients. We used the CES-D and SCID to assess current depressive symptoms and lifetime MDD, respectively, and telomere length was assessed from peripheral blood lymphocytes. Multivariate Cox regression was used to assess the association of depression, and telomere length to outcomes and the joint effect of both. Kaplan-Meier plots and log rank tests were used to compare survival time of subgroups by depression variables and telomere length. Patients with depressive symptoms (CES-D ≥16) had a 1.83-fold (95%CI= 1.08 to 3.08, P=0.024) increased risk of mortality compared to patients without depressive symptoms (CES-D < 16) and shorter disease-free survival time (P=0.004). Patients with both depressive symptoms and lifetime history of MDD were at 4.88-fold (95%CI=1.40 to 16.99; P=0.013) increased risk compared to patients with neither condition. Compared to patients without depressive symptoms and long telomere length, patients with depressive symptoms and short telomeres exhibited a 4-fold increased risk of mortality (HR=3.96, 95% CI=1.86 to 8.41, P=0.0003) and significantly shorter disease-free survival time (P<0.001). Short telomere length and depressive symptoms are associated with bladder cancer mortality individually and jointly. Further investigation of interventions that impact depression and telomere length may be warranted in cancer patients.