PDF(Pubmed)
Abstract：
BACKGROUND: Head and neck cancers (HNC) are associated with high rates of anxiety. Anxiety has been linked to biological pathways implicated in cancer progression, though little is known about its effects on overall survival. We hypothesized that higher pretreatment anxiety levels in patients with HNC would predict poorer 2-year overall survival and expected this relationship to be mediated by both systemic inflammation and tumor response to treatment.
METHODS: Patients (N = 394) reported anxiety symptomatology via the GAD-7 at treatment planning. Pre-treatment hematology workup provided an index of systemic inflammation (SII; N = 292). Clinical data review yielded tumor response and overall survival. Logistic and multiple regressions and Cox proportional hazard models tested hypothesized relationships.
RESULTS: Higher pretreatment anxiety levels were significantly associated with poorer 2-year survival (hazard ratio [HR], 1.039; 95% confidence interval [CI], 1.014-1.066, p = 0.002). The association between anxiety and SII was not significant, though anxiety was associated with poorer tumor response (odds ratio [OR], 1.033; 95% CI, 1.001-1.066, p = 0.043). Tumor response fully mediated the relationship between anxiety symptoms and 2-year survival (HR, 9.290, 95% CI, 6.152-14.031, p < 0.001).
CONCLUSIONS: Anxiety was associated with overall survival. Tumor response, but not systemic inflammation, emerged as a potential biological pathway mediating this effect. Screening for anxiety may be beneficial to help prospectively address these concerns and ameliorate potentially detrimental impact on clinically meaningful cancer outcomes.
METHODS: Patients (N = 394) reported anxiety symptomatology via the GAD-7 at treatment planning. Pre-treatment hematology workup provided an index of systemic inflammation (SII; N = 292). Clinical data review yielded tumor response and overall survival. Logistic and multiple regressions and Cox proportional hazard models tested hypothesized relationships.
RESULTS: Higher pretreatment anxiety levels were significantly associated with poorer 2-year survival (hazard ratio [HR], 1.039; 95% confidence interval [CI], 1.014-1.066, p = 0.002). The association between anxiety and SII was not significant, though anxiety was associated with poorer tumor response (odds ratio [OR], 1.033; 95% CI, 1.001-1.066, p = 0.043). Tumor response fully mediated the relationship between anxiety symptoms and 2-year survival (HR, 9.290, 95% CI, 6.152-14.031, p < 0.001).
CONCLUSIONS: Anxiety was associated with overall survival. Tumor response, but not systemic inflammation, emerged as a potential biological pathway mediating this effect. Screening for anxiety may be beneficial to help prospectively address these concerns and ameliorate potentially detrimental impact on clinically meaningful cancer outcomes.
摘要：
背景：头颈癌（HNC）与高焦虑率相关。焦虑与涉及癌症进展的生物学途径有关，尽管对其对总体生存率的影响知之甚少。我们假设HNC患者治疗前焦虑水平较高，预测2年总生存率较差，并预计这种关系是由全身炎症和肿瘤对治疗的反应介导的。
方法：患者（N=394）在治疗计划时通过GAD-7报告了焦虑症状。治疗前血液学检查提供了全身性炎症的指数(SII;N=292)。临床数据回顾产生了肿瘤反应和总生存期。Logistic和多元回归以及Cox比例风险模型测试了假设的关系。
结果：较高的治疗前焦虑水平与较差的2年生存率显着相关（风险比[HR]，1.039；95%置信区间[CI]，1.014-1.066，p=0.002）。焦虑和SII之间的关联并不显著，尽管焦虑与较差的肿瘤反应相关(比值比[OR]，1.033；95%CI，1.001-1.066，p=0.043）。肿瘤反应完全介导了焦虑症状与2年生存率之间的关系(HR，9.290，95%CI，6.152-14.031，p<0.001)。
结论：焦虑与总生存率相关。肿瘤反应，但不是全身性炎症，成为介导这种效应的潜在生物途径。筛查焦虑可能有助于前瞻性地解决这些问题，并改善对有临床意义的癌症结局的潜在有害影响。
方法：患者（N=394）在治疗计划时通过GAD-7报告了焦虑症状。治疗前血液学检查提供了全身性炎症的指数(SII;N=292)。临床数据回顾产生了肿瘤反应和总生存期。Logistic和多元回归以及Cox比例风险模型测试了假设的关系。
结果：较高的治疗前焦虑水平与较差的2年生存率显着相关（风险比[HR]，1.039；95%置信区间[CI]，1.014-1.066，p=0.002）。焦虑和SII之间的关联并不显著，尽管焦虑与较差的肿瘤反应相关(比值比[OR]，1.033；95%CI，1.001-1.066，p=0.043）。肿瘤反应完全介导了焦虑症状与2年生存率之间的关系(HR，9.290，95%CI，6.152-14.031，p<0.001)。
结论：焦虑与总生存率相关。肿瘤反应，但不是全身性炎症，成为介导这种效应的潜在生物途径。筛查焦虑可能有助于前瞻性地解决这些问题，并改善对有临床意义的癌症结局的潜在有害影响。
