Prognostic value of patient-reported depression in women with hormone-responsive early breast cancer in TEXT and SOFT

IF 5.1 2区医学 Q1 ONCOLOGY

Cancer Pub Date : 2025-09-23 DOI:10.1002/cncr.70094

Karin Ribi PhD, Bernard F. Cole PhD, Gini F. Fleming MD, Barbara A. Walley MD, Prudence A. Francis MD, Ehtesham Abdi MD, Harold J. Burstein MD, PhD, Kit L. Cheng MD, Stephen K. L. Chia MD, FRCP, Shaker R. Dakhil MD, Nancy E. Davidson MD, Stephen A. Della-Fiorentina MD, Ashley E. Frith MD, Ellis Levine MD, Sasha Lupichuk MD, Kathleen Pritchard MD, Muhammad Salim MD, Vered Stearns MD, Josephine Stewart MD, Vicente Valero MD, Andre van der Westhuizen MD, Olivia Pagani MD, Sherene Loi MD, PhD, Marco Colleoni MD, Richard D. Gelber PhD, Aron Goldhirsch MD, Alan S. Coates MD, Meredith M. Regan ScD, Jürg Bernhard PhD

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Abstract

Background

Depression has been identified as an adverse mental health outcome in women with breast cancer (BC). Depression was investigated as a risk factor for poor survival in premenopausal women with hormone-responsive early BC treated in the TEXT (Tamoxifen and Exemestane Trial) and SOFT (Suppression of Ovarian Function Trial) trials.

Methods

The data used were from a subset of patients who participated in TEXT or SOFT and completed the Center of Epidemiologic Studies-Depression scale. Associations between baseline depression-score categories and baseline characteristics were assessed using the Cochran–Mantel–Haenszel test controlling for antidepressant use. Multivariable proportional hazards regression models were used to test the association between baseline depression and disease-free survival (DFS) and overall survival (OS). Regression models were adjusted for factors known to be associated with outcomes, baseline antidepressant use, and early treatment cessation.

Results

Forty percent (2287 of 5738) of the women enrolled in the SOFT and TEXT trials were included in this analysis (SOFT, n = 1259; TEXT, n = 1028). Twenty-seven percent of women reported mild-to-moderate or severe depression at baseline. Race (p = .001), body mass index (p = .02), family history (p = .02), and performance status (p =.007) were significantly associated with the severity of depression. Relative to the no-symptomatology group, the hazard ratios (overall p = .04) for DFS were 1.34 (95% confidence interval [CI], 1.03–1.76) for women with mild-to-moderate depression and 1.34 (95% CI, 0.96–1.87) for those with severe depression. Relative to the no-symptomatology group, the hazard ratios (overall p = .008) for OS were 1.68 for mild-to-moderate depression (95% CI, 1.15–2.44) and 1.67 for those with severe depression (95% CI, 1.05–2.66).

Conclusions

In premenopausal women with hormone-responsive early BC, depression at baseline is a risk factor for poorer DFS and OFS. Further investigation of the underlying interactive processes is needed.

Trial registration

Clinicaltrials.gov NCT00066703 (SOFT) and NCT00066690 (TEXT).

Abstract Image

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在TEXT和SOFT中，患者报告的激素反应性早期乳腺癌患者抑郁的预后价值。

背景：抑郁症已被确定为乳腺癌（BC）妇女的不良心理健康结果。在TEXT（他莫昔芬和依西美坦试验）和SOFT（抑制卵巢功能试验）试验中，抑郁症作为激素反应性早期BC治疗的绝经前妇女生存不良的危险因素进行了研究。方法：使用的数据来自参加TEXT或SOFT并完成流行病学研究中心抑郁量表的患者亚组。使用Cochran-Mantel-Haenszel测试来评估基线抑郁评分类别和基线特征之间的关联，以控制抗抑郁药的使用。采用多变量比例风险回归模型检验基线抑郁与无病生存期（DFS）和总生存期（OS）之间的关系。回归模型对已知与结果、基线抗抑郁药使用和早期停止治疗相关的因素进行了调整。结果：参加SOFT和TEXT试验的女性中有40%（2287 / 5738）被纳入本分析（SOFT, n = 1259； TEXT, n = 1028）。27%的女性在基线时报告有轻度至中度或重度抑郁症。种族（p =. 001）、体重指数（p =. 02）、家族史（p =. 02）和工作状态（p =.007）与抑郁严重程度显著相关。相对于无症状组，轻度至中度抑郁症患者的DFS风险比（总p = 0.04）为1.34(95%可信区间[CI]， 1.03-1.76)，重度抑郁症患者的风险比为1.34 （95% CI, 0.96-1.87）。相对于无症状组，轻度至中度抑郁症患者OS的风险比（总p = 0.008）为1.68 (95% CI, 1.15-2.44)，重度抑郁症患者OS的风险比为1.67 （95% CI, 1.05-2.66）。结论：在激素反应性早期BC的绝经前妇女中，基线抑郁是较差的DFS和OFS的危险因素。需要进一步研究潜在的交互过程。试验注册：Clinicaltrials.gov NCT00066703 （SOFT）和NCT00066690 （TEXT）。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Cancer 医学-肿瘤学

CiteScore

13.10

自引率

3.20%

发文量

480

审稿时长

2-3 weeks

期刊介绍： The CANCER site is a full-text, electronic implementation of CANCER, an Interdisciplinary International Journal of the American Cancer Society, and CANCER CYTOPATHOLOGY, a Journal of the American Cancer Society. CANCER publishes interdisciplinary oncologic information according to, but not limited to, the following disease sites and disciplines: blood/bone marrow; breast disease; endocrine disorders; epidemiology; gastrointestinal tract; genitourinary disease; gynecologic oncology; head and neck disease; hepatobiliary tract; integrated medicine; lung disease; medical oncology; neuro-oncology; pathology radiation oncology; translational research