Research Highlights: Depression May Be Related to Survival of Patients with Renal Cell Carcinoma

Depression May Be Related to Survival of Patients with Renal Cell Carcinoma
Reviewed by: Ariel Lefland

A recent study published by PLOS ONE identified symptoms of depression and dysregulation of cortisol as key factors in predicting survival in renal cell carcinoma (RCC) patients. The study provides the first evidence of this association, controlling for disease- and treatment-related factors such as age, sex, ethnicity and disease risk index.

In a prospective study, researchers followed 217 patients with RCC, a life expectancy greater than four months, a Zubrod performance status of less than or equal to 2 and no other serious illnesses. Patients gave blood and saliva samples and completed several psychosocial questionnaires (i.e., the Centers for Epidemiologic Studies - Depression, or CES-D). Whole-genome transcriptional profiling was performed on samples from 15 patients with the highest levels of depressive symptoms. Transcript analyses indicated an up-regulation of genes involved in inflammation, immune response and negative regulation of programmed cell death and a down-regulation of genes involved in cell trafficking, adhesion, oxygen transport and hemostatis. in patients with high CES-D scores, 116 transcripts were found to be up-regulated by an average of 50% or more, and 57 transcripts were down-regulated by 50% or more. Furthermore, individuals with high CES-D scores had significantly greater tumor-associated macrophages compared to patients with low CES-D scores. Researchers also found that cortisol regulation may play a role in the correlation between symptoms of depression and cancer progression.

While this study cannot show that depressive symptoms lead to the progression of RCC, it demonstrates an important connection between psychological wellbeing and disease prognosis. More research must be conducted to determine whether depressive symptoms decrease survival rates or if RCC, in fact, causes these depressive symptoms.

PLoS ONE 7(8): e42324. 

Ariel Lefland is the 2012-2013 Research Highlights Editor