| Objective:The association between pre-diagnosis depression,anxiety symptoms,and ovarian cancer(OC)survival is unknown.This study based on the Ovarian Cancer Follow-Up Study,aimed to explore the association between pre-diagnosis depression and anxiety symptoms,different severity levels and their associated symptoms and OC survival,providing clinical research evidence for improving the survival of OC patients.Methods:1.Study population:This study was based on a prospective cohort study with 853 OC patients aged 18-79years,who were admitted and treated in Shengjing Hospital of China Medical University between January 2015 and December 2020.Structured questionnaires were used to inquire baseline characteristics of OC patients,such as demographic characteristics,lifestyle,and dietary.The hospital information management system was used to obtain the relevant clinical characteristics of OC patients.In addition,anthropometric indicators such as height,weight,waist and hip circumference were also collected.2.Exposure measures:The Patient Health Questionnaire-9(PHQ-9)and The Generalized Anxiety Disorder Scales-7(GAD-7)with well reliability and validity were used to evaluate the depression and anxiety symptoms before diagnosis,respectively.3.Outcome:Data on vital statistics were obtained annually by active follow-up of patients and record linkage to the Vital Statistics Unit in the Liaoning Center for Disease Control and Prevention.The OOPS participants were followed up until mortality from any cause or the last follow-up(March 31,2021).4.Statistical analysis:In this study,Wilcoxon and Chi-square test were used to compare the difference in baseline characteristics of OC patients with different mental status(depression and anxiety symptoms),and multiple Cox proportional hazards regression models was used to analyze the association between pre-diagnosis depression and anxiety symptoms,different severity and their combined symptoms and survival of OC patients.In this study,subgroup analysis and interaction analysis were performed according to the age at diagnosis,body mass index(BMI),menopausal status,sleep duration,sleep quality,stressful events experienced,histological type,FIGO stage,residual lesions,comorbidities and immunohistochemical indicators.To explore the stability and reliability of the results of this study.Sensitivity analyses were also performed excluding OC patients who died during the first year of follow-up,dietary changes,and BMI changes.Results:1.Study population:A total of 598 patients were included in our analysis.Up to March 31,2021,130 deaths were confirmed.We found 56(9.4%)and 235(39.3%)OC patients with depression and anxiety symptoms,respectively.2.Association between depression and anxiety and ovarian cancer all-cause mortality:Compared with non-depression symptoms,patients with pre-diagnosis depressive symptoms showed a significantly increased risk of OC mortality(HR=2.10,95%CI:1.20–3.70).Of note,the association was still robust when focusing on the OC patients with severe depressive symptoms(HR=2.10,95%CI:1.07–4.12).Interestingly,OC patients with combined moderate depression and anxiety symptoms had a significantly increased risk of OC mortality(HR=3.23,95%CI:1.14–9.11)compared with those with no symptoms of depression and anxiety.However,there was no statistical significance between pre-diagnosis anxiety symptoms and mortality in OC patients.3.Subgroup analyses stratified by different factors of the association between depression and anxiety and ovarian cancer all-cause mortality:The results of subgroup analyses showed that depressive symptoms before diagnosis were observed at the age of diagnosis≤50 years,BMI<24kg/cm~2,the total sleep time≥8 h group,the poor sleep quality group,the group without experiencing stressful events,the non-serous OC group,the group with FIGO(I-II),the remnant lesion group and the Wilms’tumor-1 negative expression group are associated with the increased risk of death in OC patients.The corresponding HR and 95%CI were 7.78(2.65-22.86),2.91(1.30-6.51),2.60(1.06-6.40),2.15(1.07-4.33),2.31(1.03-5.21),8.52(2.61-27.82),4.87(1.68-14.81)and 4.93(1.66-14.68),respectively.Meanwhile,pre-diagnosis anxiety symptoms were associated with a higher risk of death in OC patients who had experienced stressful events(HR=3.84,95%CI:1.20-12.31).In addition,age of diagnosis,histological type,menopausal status,sleep quality,FIGO stage and Wilms’tumour-1 interacted with depressive symptoms.Sleep quality,FIGO stage,residual lesions and Wilms’tumour-1 interacted with anxiety symptoms.4.Sensitivity analyses:The results of sensitivity analyses were basically consistent with those of the main analysis.After excluding OC patients who died in the first year of follow-up,pre-diagnosis depression symptom was associated with a higher mortality among OC patients,while pre-diagnosis anxiety symptom was not associated with mortality in OC patients.However,no significant association was found between depression and anxiety symptoms before diagnosis and OC patients in patients with dietary changes and weight changes.Conclusions:Pre-diagnosis depression symptom was associated with a higher mortality among OC patients.Large multicenter studies are required to confirm this finding in the future. |
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