title: Sputum interleukin-6, tumor necrosis factor-α and Salivary cortisol as new biomarkers of depression in lung cancer patients.
abstract: Depression is common among lung cancer patients. Increasing evidence has suggested that hypothalamic-pituitary-adrenal (HPA) axis and pro-inflammatory cytokines may play a key role in the pathophysiology of depression as well as cancer. This pilot study investigated the efficacy of sputum interleukin (IL)-6, tumor necrosis factor (TNF)-α and salivary cortisol as new markers to support the diagnosis of depression in lung cancer patients. The diurnal rhythms of sputum IL-6, sputum TNF-α and salivary cortisol were measured in lung cancer patients with and without depression as well as depressed controls and healthy controls. The area under the diurnal variation curves (AUC) over the 24h time course and relative diurnal variation (VAR) were calculated. Receiver operating characteristic (ROC) analysis was performed. Patients with co-morbid depression and lung cancer showed highest level of sputum IL-6 AUC, sputum TNF-α AUC and lowest level of cortisol VAR (P<0.001). As a biomarker for depression, salivary cortisol VAR demonstrated an optimal cutoff point at 77.8% (AUC=0.94; 95% CI, 0.85-0.98), which is associated with a sensitivity of 82.1% and a specificity of 96.0%. Sputum IL-6 AUC demonstrated a sensitivity of 74.4% and a specificity of 92.0% (AUC=0.81; 95% CI, 0.69-0.90). These findings suggested that higher 24h overall levels of sputum IL-6, TNF-α and flattened diurnal salivary cortisol slopes were associated with depression in lung cancer patients. Sputum IL-6 AUC and salivary cortisol VAR performed best as biomarkers in the diagnosis of depression in lung cancer patients.
authors: Lab of Integrative Medicine for Lung, Inflammation and Cancers, Huashan Hospital, Fudan University, Shanghai, China.
authors: Yi-jie
authors: YJ
authors: Du
authors: Hong-ying
authors: HY
authors: Zhang
authors: Bei
authors: B
authors: Li
authors: Xiao
authors: X
authors: Wu
authors: Yu-bao
authors: YB
authors: Lv
authors: Hua-liang
authors: HL
authors: Jin
authors: Yu-xue
authors: YX
authors: Cao
authors: Jing
authors: J
authors: Sun
authors: Qing-li
authors: QL
authors: Luo
authors: Wei-yi
authors: WY
authors: Gong
authors: Bao-jun
authors: BJ
authors: Liu
authors: Jin-feng
authors: JF
authors: Wu
authors: Shen-xun
authors: SX
authors: Shi
authors: Jing-cheng
authors: JC
authors: Dong
mesh_terms: D000704:Analysis of Variance; D003863:Depression / Q000209:etiology / Q000378:metabolism / Q000473:pathology; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism*; D015850:Interleukin-6 / Q000378:metabolism*; D008175:Lung Neoplasms / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011594:Psychometrics; D012372:ROC Curve; D012463:Saliva / Q000378:metabolism*; D013183:Sputum / Q000378:metabolism*; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism*
chemical_list: D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D006854:Hydrocortisone
keywords: ANOVA; AUC; Biomarkers; CI; Cortisol; Cytokines; Depression; Diurnal rhythm; FEV1; FVC; HADS; HAM-D; HPA; Hamilton Depression Rating Scale; Hospital Anxiety and Depression Scale; IL-6; KPS; Karnofsky Performance Status; Lung cancer; PEF; QOL; Quality of Life; RIA; ROC; SD; TNF-α; VAR; area under the diurnal variation curves; confidence interval; forced expiratory volume in 1s; forced vital capacity; hypothalamic–pituitary–adrenal; interleukin-6; one way analysis of variance; peak expiratory flow; radioimmunoassay; receiver operating characteristic; relative diurnal variation; standard deviation; tumor necrosis factor-α