By Mary Beth Nierengarten
CHICAGO -- May 2, 2008 -- Patients diagnosed with and receiving medical treatment for clinical depression prior to undergoing surgical resection for malignant brain astrocytoma do not survive as long after surgery compared with patients without depression, according to a study presented here at the 76th Annual Meeting of the American Association of Neurological Surgeons (AANS 2008).
The study included 1,052 patients with malignant brain astrocytoma (World Health Organization [WHO] grade III or IV) who underwent surgical resection between 1995 and 2006 at a single institution. Among the 1,052 patients, 49 patients (5%) were receiving medical treatment for clinical depression prior to resection; 605 patients (58%) had primary resection, 410 (39%) had secondary resection, and 37 (3.5%) underwent biopsy. Those who underwent a primary resection also received postoperative irradiation, and 26% also received temozolomide.
"Depression is not uncommon in patients diagnosed with terminal cancer," said lead author Matthew J. McGirt, MD, Director, Neuro-Oncology Surgical Outcomes Laboratory, Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, "but of emphasis in this study is that all the patients with clinical depression were being treated for depression at baseline."
No differences were found between the nondepressed and depressed groups in terms of patient and disease characteristics.
On multivariate analysis, this study found that patients treated for depression prior to surgery had a significantly higher risk of decreased survival compared with the nondepressed group, with a relative risk (95% confidence interval) of 1.41 (1.1-1.96; P < .05), with decreased survival most noted at 12 months (15% vs 41%) and 20 months (0% vs 21%) after resection for grades III and IV gliomas.
Variables that independently predicted for increased survival included decreasing age (P < .001), increasing Karnofsky peformance score (P < .001), WHO grade III versus IV (P < .001), primary versus secondary resection (P < .001), gross resection (P < .001), Gliadel wafer implantation (P = .048), postoperative temozolomide therapy (P < .001), and subsequent resection at time of recurrence (P < .001).
Although Dr. McGirt emphasised that no definitive conclusions can be drawn from what is only an observational study, he suggested that "one implication of the study is that depression is an important and relevant comorbidity in these patients and that adequate diagnosis and treatment may affect survival."
[Presentation title: Association of Preoperative Depression and Survival After Resection of Malignant Brain Astrocytoma. Abstract 608]
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