title: Depression, immunity, and survival in patients with hepatobiliary carcinoma.
abstract: OBJECTIVE
  The aims of the present study were to assess the prevalence of depressive symptoms at diagnosis, test the association between depressive symptoms and survival, and preliminarily test a mediational model of depression, immunity, and survival in patients with hepatobiliary carcinoma (HBC).
  
  
  METHODS
  One hundred one patients diagnosed with HBC were prospectively studied. Depressive symptoms were measured at diagnosis using the Center for Epidemiological Studies Depression Scale (CES-D). Sociodemographic and disease-specific data were gathered from the patients' charts. In a subsample of patients, stress; alcohol, tobacco, and drug use; sleep quality; physical activity; social support; natural killer (NK) cell number and cytotoxicity; and plasma levels of interleukin (IL) -4, IL-5, tumor necrosis factor alpha, and interferon gamma were measured. Survival was measured from date of diagnosis to death.
  
  
  RESULTS
  At diagnosis, 37% of patients reported a CES-D score of > or = 16 (clinical range). Using Cox regression analysis, sociodemographic and disease-specific variables and CES-D score significantly predicted survival (Breslow chi2 = 32.4, P = .006). Only vascular invasion (P = .001) and CES-D score > or = 16 (P = .03) were significant predictors. In a subsample of 23 patients, patients who reported a CES-D score of > or = 16 were found to have significantly lower NK cell numbers than patients who reported a CES-D score of less than 16 (F1,21 = 9.39, P = .003). A robust trend was found in which NK cell number was associated with survival. A mediational model linking depressive symptoms and survival, with NK cell number as a mediator, was preliminarily supported.
  
  
  CONCLUSIONS
  Secondary to the high prevalence of depressive symptoms and impact on survival, psychological and pharmacologic interventions should be designed and implemented in patients diagnosed with HBC.
authors.affiliation: University of Pittsburgh School of Medicine, Liver Cancer Center, Department of Surgery, Starzl Transplantation Institute, Pittsburgh, PA 15213, USA. steeljl@msx.upmc.edu
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Steel
authors.forename: David A
authors.initials: DA
authors.lastname: Geller
authors.forename: T Clark
authors.initials: TC
authors.lastname: Gamblin
authors.forename: Marion C
authors.initials: MC
authors.lastname: Olek
authors.forename: Brian I
authors.initials: BI
authors.lastname: Carr
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001661:Biliary Tract Neoplasms / Q000276:immunology / Q000401:mortality / Q000523:psychology; D016207:Cytokines / Q000097:blood; D003863:Depression / Q000150:complications / Q000453:epidemiology*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D007694:Killer Cells, Natural / Q000276:immunology; D008113:Liver Neoplasms / Q000276:immunology / Q000401:mortality / Q000523:psychology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D016019:Survival Analysis
chemical_list: D016207:Cytokines