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.
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。