The Effects Of Depression On Clinical Prognosis And Immune Inflammatory Reaction In Patients With Ovarian Cancer

ObjectiveTo analyze the effects of depression on the levels of inflammation cytokines,cellular immune function and tumor markers CA125,human epididymis protein-4(HE4),serum insulin like growth factor-1 (IGF-1) in patients with ovarian cancer and the ralations among them and clinical prognosis.MethodsWe selected 130 cases patients with ovarian cancer who were diagnosed as clinical stage III (International Federation of gynecology and obstetrics Association, FIGO) in department of gynaecology in Feichegn mining cencer hospital from 2010 January to 2013 January. All patients were in accordance with FIGO clinical stage Ⅱ-Ⅲ. Based on the standard of Beck Depression Inventory scale scores, the patients were admitted to hospital and divided into nomal group(24 cases),mild depression group(21 cases), moderate depression group(36 cases) and severe depression group(49 cases).In the morning on the date of detection, The fasting peripheral blood was respectively taken for measurement of lymphocyte count analysis and changes of T cell subsets by flow cytometry and to analyse the ratio of CD3,CD4,CD8 positive cells, nature killer cells and regulatory T cells(CD4+CD25+Tcells) subsets.Our ourpose was to acquire the comparative analysis of immune function of patients in the two groups. We detected the levels of CA125,human epididymis protein-4 and insulin like growth factor-1 (IGF-1) in serum and ascites by the technology of ECLIA and ELISA and used enzyme-linked immunosorbent assay method for the detection of serum interleukin-6(IL-6),tumor necrosis factor-a(INF-a) and the particle enhanced immuno turbidimetric menthod for the detection of plasma D-dimer level and analyzed the levels of platelet count by blood analyzer. Following up for two years, we had a comparison on the clinical survival difference between the four groups.Results1、The change of cellular immune function: The percentage of blood plasma CD4+ T cells in normal group, mild depression group, moderate depression group and severe depression group were respectively [(37.93±6.28)%,(33.04±5.29)%, (27.91±6.05)%,(21.38±4.76)%,F=2.898,P=0.005];the onesof plasma CD8+ T cells in normal group, mild depression group, moderate depression group and severe depression group were respectively [(28.82±5.16)%,(29.05±4.28)%, (31.84±3.79)%, (34.39±3.16)%,F=2.653,P=0.005]; The percentage of CD3+T cells were respectively [(72.48±6.73)%,(70.65±5.86)%,(67.36±4.94)%,(63.10±3.40)%,F=3.039,P=0.003];Th e percentage of Nature killer cells were respectively [(25.84±3.96)%, (23.86±4.05)%, (19.58±3.78)%,(16.26±3.81)%,F=2.684,P=0.005]; The percentages of CD4+CD25+ T cells were respectively [(8.93±1.37)%,(14.95±3.86)%,(28.36±4.89)%, (34.26±5.75)%,F=3.068,P=0.003]; the peripheral blood lynmphocyte counts were respectively [(1.47±0.39) ×109/L,(1.52±0.33)×109/L,(1.32±0.39) ×109/L,(1-11±0.40) ×109/L,F=2.8848,P=0.003].The difference among the fouer groups was statistically significant(P<0.05).2、The levels of CA125,human epididymis protein-4 and insulin like growth factor-1 (IGF-1) in serum and ascites: The levels of serum CA125 in normal group, mild depression group, moderate depression group and severe depression group were respectively [(32.81±3.76) U/mL,(39.16±4.28)U/mL,(51.36±5.27) U/mL,(79.35±8.28) U/mL,F=3.895,P=0.001]; The levels of serum HE4 in normal group, mild depression group, moderate depression group and severe depression group were respectively [(345.87±89.26)pmol/L,(376.28±78.53) pmol/L,(412.38±81.36) pmol/L, (465.28±90.21) pmol/L,F=3.158,P=0.003]; The levels of serum IGF-1 were respectively [(187.37±45.28)ng/mL,(179.28±51.89) ng/mL,(168.27±69.02) ng/mL,(121.58±42.31) ng/mL,F=2.853,P=0.005]; The levels of ascites CA125 in normal group, mild depression group, moderate depression group and severe depression group were respectively [(38.39±4.28) U/mL,(47.16±5.05)U/mL, (59.84±6.03) U/mL,(88.26±8.94) U/mL,F=3.683,P=0.001]; The levels of ascites HE4 in normal group, mild depression group, moderate depression group and severe depression group were respectively [(368.27±90.26)pmol/L,(399.26±88.63) pmol/L,(456.82±89.75) pmol/L,(499.64±93.58) pmol/L,F=3.263,P=0.003]; The levels of ascites IGF-1 were respectively [(154.49±41.06)ng/mL,(168.16±47.35) ng/mL,(139.51±42.92) ng/mL,(105.38±37.28) ng/mL,F=2.990,P=0.005];The correlation coefficient of CA125, HE4, IGF-I in serum and ascites were 0.863,0.617,0.361.3、The plasma D-dimer and platelet count levels:The levels of blood plasma PLT counts in normal group, mild depression group, moderate depression group and severe depression group were respectively [(159.68±36.71)×109/L,(168.25±47.03) ×109/L,(171.90±52.64)×109/L,(316.85±69.17) ×109/L,F=3.048,P=0.003];the ones of plasma D-dimer in normal group, mild depression group, moderate depression group and severe depression group were respectively [(2.04±0.57)ng/mL,(2.13±0.68) ng/mL,(2.39±0.98) ng/mL,(4.85±1.03) ng/mL,F=3.264,P=0.003].The difference among the four groups was statistically significant(P<0.05).4、The levels of inflammatory factors in serum: The levels of plasma IL-6 in normal group, mild depression group, moderate depression group and severe depression group were respectively [(24.86±5.95) ng/L,(29.03±8.28) ng/L,(38.05±7.03) ng/L,(56.82±11.34) ng/L,F=3.216,P=0.003]; the ones of plasma TNF-a in normal group, mild depression group, moderate depression group and severe depression group were respectively [(28.94±7.05)ng/mL,(36.19±7.03) ng/mL,(43.01±7.85) ng/mL,(79.16± 13.06) ng/mL,F=3.471,P=0.003].The difference among the four groups was statistically significant(P<0.05).5、Following up 24 months, the survival period of illness free progression in normal group, mild depression group, moderate depression group and severe depression group were respectively [(6.93±2.38) months,(7.09±3.87) months,(5.26±2.76) months,(4.87±1.94) months,F=2.695,P=0.005]; the median survival period were respectively [(31.93±5.61) months,(30.68±6.29) months,(28.16±5.35) months,(21.46±6.41) months,F=2.9045,P=0.005]; the One year survival rate were respectively [(23/24,95.83%),(20/21,95.24%),(31/36,86.11%), (40/49,81.63%),F=2.898,P=0.005]; the two year survival rate were respectively [(17/24,70.83%),(15/21,71.42%),(22/36,61.11%),(20/49,40.82%),F=3.904,P=0.001]. The difference among the four groups was statistically significant(P<0.05).Conclusion1、The patients with ovarian cancer who are diagnosed as clinical Ⅱ～Ⅲ stage(International Federation of gynecology and obstetrics Association, FIGO) are always in different degrees of depression condition.2、Depression can affect the levels of micro inflammation and increase excitation of serum interleukin-6,tumor necrosis factor-a levels in patients with ovarian cancer.3、Depression can regulate down the body immune response,inhibit the levels of the proportion of T cells and make the immune regulatory function imbalance state. Especially in the patients with severe depression,the ratio levels of CD3+,CD4+,nature killer cells decrease more obviously and furtherly reduce the body immunity.4、Depression makes the levels of CA125,human epididymis protein-4,insulin like growth factor-1 in serum and ascites increase and promote tumor progression and increase recurrence probability.5、The patients with ovarian cancer are in the existence of hyprcoagulable state.Depression associated with tumor can increase the levels of the platelet counts and make the levels of D-dimer increase.6、Depression with different level states can influence the clinical free progression survival period and reduce the clinical survival rate in patients with ovarian cancer who were diagnosed as clinical stage Ⅱ-Ⅲ (International Federation of gynecology and obstetrics Association, FIGO).