根據(jù)一項新的研究證實：抑郁癥癥狀與癌癥患者的生存時間較短相關。近日,，得克薩斯大學MD安德森癌癥中心研究人員在8月1日的PLoS ONE雜志上發(fā)表論文稱：這種相關性可能是由于應激激素調節(jié)異常和炎癥基因表達導致的,。
腫瘤學和行為科學中心部門教授Lorenzo Cohen說：研究發(fā)現(xiàn)心理健康和社會福祉良好是可以影響生物過程以及影響癌癥發(fā)展的。該研究還表明,，心理健康篩查應該是標準治療的一部分,，因為這是公認的可以幫助人們管理困擾的方法，即使在面對危及生命疾病的情況下,。
在研究中,，研究人員分析了超過217例新診斷腎細胞癌已經(jīng)擴散五年的患者。參與人員回答了研究者的宗教和精神問題,。他們還詢問了他們的抑郁癥癥狀,、生活質量和應對技能等?；颊咭蔡峁┝搜簶颖?，以及5個唾液樣本，每天一次共三天,。
研究人員使用唾液樣本來跟蹤患者的皮質醇,、應激激素的全天變化情況，發(fā)現(xiàn)通常是在早晨高,，之后會下降。在跟蹤分析時,，64％的患者已經(jīng)死亡,。這些患者被確診后存活的平均時間為1.8年。
總的來說這項研究表明,，23％的患者存在臨床抑郁癥,。即使考慮其他疾病相關的危險因素后，研究者指出,，抑郁癥也是會導致存活時間較短,。此外，研究表明體內皮質醇水平全天都高于正常水平也會降低癌癥患者的生存。
使用15例存在抑郁癥最顯著的癥狀患者與抑郁癥最溫和患者的15個組織樣本,，研究人員進行全基因組分析,，以確定是否憂郁癥與癌癥死亡的風險增加有關。他們發(fā)現(xiàn)調節(jié)細胞炎癥的特定信號通路在抑郁癥癌癥患者表達水平明顯提高,，在這種相關性中起到了關鍵作用,。
這項研究的作者得出結論：患者的心理健康和生存時間之間的聯(lián)系與炎癥基因表達調控相關。研究結果表明,，現(xiàn)在能夠確定一些可能的機理來解釋抑郁癥和生存之間的關聯(lián),。雖然這項研究發(fā)現(xiàn)抑郁癥和癌癥存活率之間的關聯(lián)，但它并不能證明兩者之間的因果關系,。（生物谷：Bioon.com）
doi:10.1371/journal.pone.0042324
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Depressive Symptoms and Cortisol Rhythmicity Predict Survival in Patients with Renal Cell Carcinoma: Role of Inflammatory Signaling
Lorenzo Cohen1*, Steven W. Cole2, Anil K. Sood3, Sarah Prinsloo1, Clemens Kirschbaum4, Jesusa M. G. Arevalo2, et al.
Purpose
Evidence has supported the association between psychological factors and cancer biology; however, findings are equivocal on the role of psychosocial factors in cancer progression. This study generates a hypothesis of mechanistic variables by examining the clinical effects of psychosocial factors and cortisol dysregulation in patients with metastatic renal cell carcinoma (RCC) and examines associated activation of transcription control pathways.
Methods
Patients with metastatic RCC (n = 217) were prospectively enrolled in this study. Patients completed questionnaires (Centers for Epidemiologic Studies – Depression; SF-36 Health Status Survey; Duke Social Support Index; Coping Operations Preference Enquiry; organized and non-organized religious activity; and intrinsic religiosity), and provided blood and saliva samples. Cortisol levels and whole genome transcriptional profiling were assessed to identify potential alterations in circadian rhythms and genomic pathways.
Results
Separate Cox regression models, controlling for disease risk category, revealed that CES-D scores (p = 0.05, HR = 1.5, 95% CI for HR: 1.00–2.23) and cortisol slope (p = 0.002; HR = 1.9; 95%CI for HR: 1.27–2.97) were significantly associated with decreased survival. Only cortisol slope and risk category remained significant in the complete model. Functional genomic analyses linked depressive symptoms to increased expression of pro-inflammatory and pro-metastatic genes in circulating leukocytes. 116 transcripts were found to be upregulated by an average of 50% or more in high CES-D patients, and 57 transcripts downregulated by at least 50%. These changes were also found in the tumor in a subset of patients.
Conclusion
These findings identify depressive symptoms as a key predictor of survival in renal cell carcinoma patients with potential links to dysregulation of cortisol and inflammatory biology.
