Article
Antidepressant use and risk of disease recurrence after radical cystectomy for bladder cancer
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Authors
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Tina Schubert
- Uniklinik Würzburg
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Fahmy Hassan
- Uniklinik Würzburg
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Manuel Alexander Schmid
- Uniklinik Würzburg
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Markus Renninger
- Uniklinik Würzburg
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Arnulf Stenzl
- Uniklinik Würzburg
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Hubert Kübler
- Uniklinik Würzburg
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Georgios Gakis
- Uniklinik Würzburg
| Published: | May 17, 2018 |
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Outline
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Purpose: Long-term use of antidepressive drugs has been linked to the development of solid tumors, i.e cervical cancer. In bladder cancer cell lines, 5-hydroxytryptophan metabolites were recently found to increase the epithelial to mesenchymal transition and induce immune escape mechanisms of cancer cells. The purpose of this study was to examine the prognostic outcome of patients with a history of antidepressant use after radical cystectomy (RC) for bladder cancer (BC). Material and
Methods: We retrospectively identified a total of 328 consecutive patients who were diagnosed and treated with RC for BC between 2002 and 2013. Detailed information on the use of antidepressant drugs prior to RC was obtained and correlated with standard histopathologic and clinical parameters. Recurrence-free survival (RFS) was estimated using Kaplan-Meier method and multivariable Cox-proportional hazard regression analysis for risk factors of disease recurrence. The median follow-up was 31 months (5-49).
Results: At the time of RC, 13 (4.0%) of the 328 patients had a history of use of antidepressant medication. The use of antidepressants was associated with increased tumor size (continuously coded; p=0.014), preoperative thrombocytosis (p=0.024), intake of sedative/anxiolytic medication (p=0.016) and receipt of palliative chemotherapy (p=0.014). The median 3-year RFS was 31.3% for patients with antidepressant use and 57.3% for those without (p=0.017). On multivariable analysis, adjusted for all significant variables of univariable analysis and standard histopathological risk factors, lymph node positive disease (p=0.006), positive surgical margins (p=0.020), preoperative hydronephrosis (p=0.036) and use of antidepressants (p=0.030) remained independent predictors of disease recurrence.
Conclusions: In this study, the number of patients with long-term use of antidepressants prior to RC was low and associated with an increased risk of disease recurrence. Further studies are needed to confirm these findings and to investigate possible causes of an altered 5-hydroxytryptophan metabolism on BC progression.
