肝癌患者术前的抑郁情绪与术后复发相关性的临床研究

A clinical study on the relationship between preoperative depression and recurrence in patients with hepatocell ular carcinoma

目的前瞻性地探讨肝细胞癌(Hepatocellular Carcinoma,HCC)患者外科手术前的抑郁状态与治疗后复发的关系。方法纳入2009年1月至2010年1月接受手术的124例HCC患者,术前行近3～5天的抑郁状态进行测定,并采用抑郁自评量表进行评分。以评分数的中位数为界值,分为高抑郁评分组及低抑郁评分组。随访截止至2012年3月。应用Kaplan-Meier生存分析判别术前肝癌患者的抑郁状态与术后复发的关系,并以COX比例风险模型分析肝癌术后复发的独立危险因素。结果肝癌病人术前的抑郁评分(SDS评分)高于国内常模(P=0.007)。高抑郁评分组和低抑郁评分组的术后1、2年复发率分别为:9.5%、11.4%vs 19.1%、37.2%(P=0.036)。进一步行COX比例风险模型多因素分析得出与预后有关因素为:SDS评分高、微血管癌栓侵犯、肿瘤最大径大于5 cm、肿瘤个数多发(P<0.05)。结论肝癌患者术前的抑郁情绪与术后复发密切相关,预防与治疗肝癌患者的抑郁状态是降低肝癌术后复发率的重要途径之一。

Objective To prospectively investigate the relationship between preoperative depression and recurrence in patients with hepatocellular carcinoma （HCC） after hepatectomy. Methods From January 2009 to January, a total of 124 HCC patients who underwent hepatectomy were preoperatively measured depression SDS score for 3 - 5 days. Using median SDS score as the cutoff value, We divided the patients into high depression score group and low depression score group. Follow-up ended on 31 st March 2012. Kap- lan-Meier survival analysis was used to assess the relationship between preoperative depression and postoperative recurrence. The Cox proportional hazards model analysis was used to distinguish independent risk factor for HCC recurrence. Results The mean preopera- tive depression score （SDS score） of patients with HCC was significantly higher than that of the national norm （P = O. 007 ）. The 1, 2-year cumulative recurrence rates of high and low depression group were： 9. 5%, 11.4% vs. 19.1% , 37.2%, respectively （P = 0. 036）. Further multivariate analysis showed that the independent prognostic factors as follows ： SDS score, microvascular invasion, tumor size, and multiple nodules （P 〈 0. 005）. Conclusions The preoperative depression and recurrence of HCC patients are closely related. The prevention and treatment of depression are beneficial to the decrease of recurrence rate in patients with HCC.