术前焦虑与抑郁状态对肝细胞癌根治术后长期预后影响的前瞻性队列研究

A prospective cohort study of the impact of preoperative anxiety and depression on long-term outcomes after radical treatment for hepatocellular carcinoma

摘要:

背景与目的:肝细胞癌（HCC）术后复发率高、远期预后不佳。随着生物-心理-社会医学模式的发展，心理因素在肿瘤预后中的作用逐渐受到关注，但术前焦虑与抑郁对HCC术后长期生存的影响尚缺乏前瞻性证据。本研究旨在探讨术前焦虑与抑郁状态对HCC患者根治性治疗后预后的影响。 方法:本研究为单中心前瞻性队列研究，连续纳入2019年接受根治性肝切除或消融的HCC患者213例。采用Zung焦虑自评量表（SAS）和抑郁自评量表（SDS）评估术前心理状态。主要终点为总生存期（OS），次要终点为无病生存期（DFS）。采用Kaplan-Meier法及Cox比例风险模型分析预后影响因素。 结果:术前焦虑和抑郁检出率分别为37.6%和31.0%，45.1%患者存在至少一种心理困扰。Kaplan-Meier分析显示，焦虑或抑郁患者的DFS和OS均明显降低（均P<0.05）。多因素分析中，焦虑或抑郁单独纳入模型未显示独立预测价值，但合并为“焦虑或抑郁状态”后，成为DFS（HR=1.589，P=0.003）和OS（HR=1.844，P<0.001）的独立不良预后因素。此外，CNLC分期、手术方式及MVI亦为独立影响因素。 结论:术前焦虑与抑郁在HCC患者中较为常见，并与术后生存不良显著相关。综合评估心理困扰较单一症状更具预后价值，提示应将心理筛查纳入围手术期管理。

Abstract:

Background and Aims: Hepatocellular carcinoma (HCC) is characterized by a high recurrence rate and unsatisfactory long-term outcomes after curative treatment. With the development of the bio-psycho-social model, the role of psychological factors in cancer prognosis has gained increasing attention. However, prospective evidence regarding the impact of preoperative anxiety and depression on survival in HCC remains limited. This study aimed to evaluate their association with long-term outcomes after curative treatment. Methods: This single-center prospective cohort study consecutively enrolled 213 HCC patients who underwent curative resection or ablation in 2019. Preoperative psychological status was assessed using the Zung Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS). Overall survival (OS) was the primary endpoint, while disease-free survival (DFS) was the secondary endpoint. Survival analyses were performed using the Kaplan-Meier method and Cox regression models. Results: The prevalence of preoperative anxiety and depression was 37.6% and 31.0%, respectively, with 45.1% of patients exhibiting at least one condition. Patients with anxiety or depression had significantly worse DFS and OS (both P<0.05). In multivariable analysis, neither anxiety nor depression alone was independently associated with outcomes. However, the combined variable ("anxiety or depression") independently predicted poorer DFS (HR=1.589, P=0.003) and OS (HR=1.844, P<0.001). CNLC stage, surgical approach, and microvascular invasion were also identified as independent prognostic factors. Conclusion: Preoperative psychological distress is common in HCC patients and is associated with unfavorable long-term outcomes. A composite assessment of anxiety and depression provides greater prognostic value than individual symptoms, supporting the integration of psychological screening into perioperative management.