Stress, depression, the immune system, and cancer. Lancet Oncol. 2004;5:617-625. [PMID: 15465465 DOI: 10.1016/s1470-2045(04)01597-9]

Depressive Disorder Affects TME and Hormonal Changes Promoting Tumour Deterioration Development

Cancer patients often suffer from depression, the presence of which promotes the deterioration of the cancer patient's condition and thus affects the patient's survival. However, the exact mechanisms underlying the relationship between depression and tumour progression remain unclear, and this complexity involves multi-system and multi-level interactions, with several key challenges remaining in current research. First, the extreme complexity of biological systems. Depression and tumors involve multiple pathways such as neuroendocrine, immune system, and metabolism, respectively, and there are nonlinear interactions between these pathways (e.g., HPA axis activation affects both immunosuppression and tumor angiogenesis), so it is difficult to isolate the predominant role of a single mechanism, and there are feedback loops (e.g., inflammatory factors (e.g., IL-6) can both induce depressive symptoms and promote tumor growth) form a "feedback loop between depression and tumors" that makes it difficult to determine the direction of causality. Second, the potential blind spot of mechanism research. There is insufficient direct evidence for the brain-tumor axis, and it is known that the vagus nerve or sympathetic nerves can directly modulate the tumor microenvironment (TME) (e.g., via β-adrenergic receptors), but there is a lack of technical support for in vivo imaging on how the CNS remotely affects tumors through the neural circuits; whereas depression-associated disturbances of the intestinal flora or in certain stages of tumor development (e.g., metastatic) or specific microenvironments (e.g., areas of hyper-infiltrating T-cells) may have long-term effects on the tumors, but such changes are difficult to capture in short-term experiments and cannot be precisely temporally resolved by existing technologies. However, there are limitations in current research methods. Existing studies have relied on mouse models of chronic stress (e.g., chronic unpredictable stress), but the "depression-like behaviour" of mice is fundamentally different from the clinical manifestations of depression in humans, and the TME (e.g., immune composition) is different from that of humans. Finally, for patients with cancer-associated depression, clinical treatment is usually a two-pronged strategy, but the combination of anticancer and antidepressant drugs has limitations, such as drug-drug interactions, safety issues, and the challenge of individualised treatment in clinical practice. Therefore, by elucidating the relationship between depression and tumour bidirectional effects, this review relatively clarifies how depression affects TME to promote tumour progression by influencing changes in immunosuppression, hormonal changes, glutamate/glutamate receptors, and intestinal flora. Further, some potential therapeutic strategies are proposed for the clinical treatment of this group of patients through the above pathological mechanism; at the same time, it was found that antidepressant drugs have potential antitumor activity, and their dual pharmacological effects may provide synergistic therapeutic benefits for patients with cancer-associated depressive disorders. This finding not only expands the choice of drugs for tumour therapy but also provides a new theoretical basis for comprehensive treatment strategies in the field of psycho-oncology.

Psychosomatic Bias in Low-dose Radiation Epidemiology: Assessing the Role of Radiophobia and Stress in Cancer Incidence

ABSTRACT

Historical assessment of radiation effects at low doses (below 0.2 Sv) are generally the result of back extrapolation from higher doses, which are known to have a linear relation between risk and dose. There are multiple counter-examples, and some literature argues that a threshold, nonlinear, or even a beneficial effect (hormeisis) can occur from radiation below these doses. The common theme found in all of these studies stems from the traditional approach of correlating disease rates to stimulus and then effectively curve-fitting the result toward zero dose. What has not been considered in general are the personal stress levels of the exposed individuals due to fear of cancer from low doses. The increased levels of cortisol due to the psychological stress from fear or depression has been shown in the literature to increase cancer probability. The extent to which low-dose exposed individuals were highly fearful or stressed from the radiation exposure would then give rise to elevated cancer based on stress rather than a fundamental radiogenic mechanism. If the population under epidemiological study is aware of a potential historical exposure (no matter how small) and has then lived under stress from fear or depression due to that exposure, the psychosomatic effects will bias the epidemiology accordingly and so should be quantified and accounted for as done with the effects of smoking.Health Phys. 129(0):000-000; 2025.

Decoding the neuroimmune axis in colorectal cancer: From neural circuitry to therapeutic innovation

The nervous and immune systems are two major components that maintain body homeostasis, with their functional roles often overlapping significantly. Both systems are capable of identifying, integrating, and organizing responsive reactions to various external stimuli. The gut, referred to as the "second brain" and the largest immune organ in the body, serves as the most frequent focal site for neuroimmune interactions. Colorectal cancer (CRC), as the predominant solid tumor arising in this neuroimmune-rich microenvironment, remains understudied through the lens of neuroimmune regulatory mechanisms. This review systematically synthesizes current evidence to elucidate the neuroimmune axis in CRC pathogenesis, with particular emphasis on neuroimmune crosstalk-mediated remodeling of tumor immunity. We comprehensively catalog the immunomodulatory effects exerted by principal neuroregulatory mediators, categorized as: (1) neurotransmitters (glutamate, glutamine, γ-aminobutyric acid, epinephrine, norepinephrine, dopamine, serotonin, acetylcholine, and gaseous signaling molecules); (2) neuropeptides (substance P, calcitonin gene-related peptide, vasoactive intestinal peptide); and (3) neurotrophic factors. Furthermore, we critically evaluate the translational prospects and therapeutic challenges of targeting neuroimmune pathways and propose strategic priorities and research focuses for advancing the development of neuroimmune interaction-related therapeutic approaches in CRC.

Unravelling behavioural contributions to IBS risk: evidence from univariate and multivariate Mendelian randomisation

Background

While numerous studies have investigated the link between behavioural factors and irritable bowel syndrome (IBS), the causal relationships remain unresolved. This study applied Mendelian randomisation (MR) analysis to assess the causal impact of specific behavioural factors on IBS risk.

Methods

Bidirectional Mendelian randomisation analysis was employed to evaluate the causal relationships between behavioural factors and IBS risk. A genome-wide significance threshold (P < 5e-6) was applied to identify associations between genetic variants and behaviour-related traits, ensuring robust selection of instrumental variables for evaluating potential causal effects. Genetic correlations with IBS were sourced from extensive genome-wide association studies (GWASs). Various statistical methods were applied to estimate the causal effects.

Results

This study employed both univariate and multivariate Mendelian randomisation analyses to investigate the causal relationships between specific behavioural factors and the risk of irritable bowel syndrome (IBS). The results indicated that body mass index (BMI) (odds ratio (OR) = 1.074; 95% confidence interval (CI) = 1.025-1.125, P = 0.031), insomnia (OR = 1.986; 95% CI = 1.652-2.389, P < 0.001), duration of mobile phone use (OR = 1.120; 95% CI = 1.018-1.232, P = 0.021), and weekly mobile phone usage time in the past three months (OR = 1.148; 95% CI = 1.016-1.298, P = 0.021,) were associated with an increased risk of IBS. In contrast, usual walking speed (OR = 0.756; 95% CI = 0.621-0.920, P < 0.001), non-smoking status (OR = 0.779; 95% CI = 0.645-0.941, P < 0.001), and weekly alcohol consumption (OR = 0.862; 95% CI = 0.743-0.999, P = 0.015) were associated with a reduced risk of IBS. Furthermore, in the multivariate Mendelian randomisation analysis, no statistically significant causal associations were found for BMI, usual walking pace, length of mobile phone use, and smoking status. Weekly mobile phone usage time in the past three months (OR = 1.439; 95% CI = 1.126-1.840, P = 0.0037,) and insomnia (OR = 1.468; 95% CI = 1.076-2.003, P = 0.0156) were identified as risk factors, while weekly alcohol intake (OR = 0.813; 95% CI = 0.677-0.975, P = 0.0257) acted as a protective factor.

Conclusions

This study identified BMI, insomnia, duration of mobile phone use, and weekly mobile phone usage time in the past three months as risk factors for IBS. In contrast, weekly alcohol consumption, usual walking pace, and non-smoking status were observed as protective factors. Additionally, in multivariable analysis, weekly mobile phone use, insomnia, and weekly alcohol consumption showed a direct influence on IBS risk when considered simultaneously.

Differential associations of serum globulin and albumin-globulin ratio with depression in cancer and non-cancer populations: a cross-sectional study

Objective

The association of globulin and albumin-globulin ratio (AGR) with depression in cancer and non-cancer populations remains understudied. Therefore, this study aims to investigate this association and potential differences, with a focus on cancer-specific pathophysiology.

Methods

This study utilized data from the National Health and Nutrition Examination Survey (NHANES) conducted from 2005 to 2016. The participants were divided into three tertiles of globulin and AGR to explore more detailed associations. Logistic regression, restricted cubic spline (RCS) curves, and subgroup analyses were conducted to assess the associations. Finally, receiver operating characteristic (ROC) curves were applied to evaluate the predictive performance of globulin and AGR for depression.

Results

After adjusting for covariates, higher globulin levels were significantly associated with an increased incidence of depression in cancer patients (OR=2.53, 95% CI: 1.69-3.80), while a higher AGR was associated with a reduced incidence (OR=0.28, 95% CI: 0.14-0.58). In the non-cancer group, a similar but weaker association was observed: higher globulin levels (OR=1.16, 95% CI: 1.00-1.35) and lower AGR (OR=0.80, 95% CI: 0.62-1.05) were associated with depression. Subgroup analyses suggested that the associations were more stable in cancer populations, while in non-cancer populations, these associations might be influenced by drinking. AUC values indicated that the biomarkers demonstrated good predictive performance.

Conclusion

This study identifies globulin and AGR as novel, cost-effective biomarkers that integrate inflammation and nutrition, providing a convenient and robust means to predict depression, particularly in cancer patients. These findings also offer new perspectives for future dual clinical interventions targeting inflammation and nutrition, as well as experimental research on depression.

Increased risk of herpes zoster associated with stress and sleep deprivation: Evidence from korea health panel survey

OBJECTIVE

Several studies have reported controversial results regarding the association between mental health factors and the risk of herpes zoster. This study examined the effects of self-rated stress, sleep deprivation, depressive symptoms, and suicidal ideation on the risk of herpes zoster.

METHODS

Data from the Korea Health Panel Survey (2008-2018) were analyzed. Associations between self-reported mental health factors and herpes zoster were determined using a generalized estimating equation model. Age, sex, socioeconomic status, health behaviors, and comorbidities were adjusted for in the model. The standardized incidence ratios (SIRs) were reported from the sensitivity analysis.

RESULTS

Of the 78,896 included person-years (mean age, 51.31 ± 16.90; females, n = 43,503 [55.14 %]), 1130 (1.43 %) developed herpes zoster. The adjusted odds ratios (aORs) for the association between severe self-rated stress and herpes zoster were 1.483 (95 % confidence interval [CI]: 1.161-1.895) and for sleep deprivation, 1.194 (95 % CI: 1.038-1.374). When stratified by sex, the association remained significant in females but not in males. For depressive symptoms and suicidal ideation, the adjusted models did not reveal significant associations with herpes zoster infection. In the sensitivity analysis, the SIRs for herpes zoster were higher with severe self-rated stress (1.37, 95 % CI: 1.07-1.68) and sleep deprivation (1.21, 95 % CI: 1.07-1.36).

CONCLUSIONS

Severe self-rated stress and sleep deprivation were associated with an increased risk of herpes zoster, whereas depressive symptoms and suicidal ideation were not. Further studies are required to confirm these findings and explore additional factors.

Sick Leave due to Stress and Subsequent Cancer Risk, a Swedish National Registry Study of 516,678 Cancer Cases

BACKGROUND

This study examined whether sick leave due to severe stress (stress leave) and duration of leave are associated with future cancer risk.

METHODS

We conducted a matched case-control study using complete-population data from Swedish national registers (2005 to 2018), including 516,678 primary cancer cases and 2,357,433 matched controls. Odds ratios (OR) were calculated by conditional logistic regression and adjusted for pre-specified confounders.

RESULTS

Stress leave of any duration, reported to the Swedish Social Insurance Register, was associated with a slightly increased cancer risk, with the highest risk estimate for 1-30 versus 0 days (adjusted OR 1.05, 95% CI 1.02-1.09). In men, a clear exposure-response trend was present. We observed increased risks of prostate cancer (adjusted OR for > 90 days: 1.10, 95% CI 1.01-1.20) and cervical cancer (adjusted OR for > 90 days: 1.11, 95% CI 1.05-1.17, including cancer in situ). In etiology-based analyses, a positive association was found for smoking-related cancers, and the risk relationship for non-cervical HPV-related cancers was similar to that for cervical cancer. Risk estimates were above one for several types of stress in relation to overall cancer risk, including an exposure-response trend for acute stress reactions (p-trend 4.0 × 10-4) but a null association for post-traumatic stress disorder.

CONCLUSIONS

Stress leave was associated with a modestly higher risk of cancer overall and prostate and cervical cancers specifically. Regardless of whether the link is biological or reflective of lifestyle mediators or for cervical cancer, lower participation in screening, these findings suggest a potential relevance of severe stress for cancer prevention.

Different action of glucocorticoid receptor in adipose tissue remodelling to modulate energy homeostasis by chronic restraint stress

BACKGROUND

Chronic stress in daily life is a well-known trigger for various health issues. Despite advancements in obesity research, the mechanisms governing lipid metabolism in adipose tissue during cachexia remain poorly understood.

METHODS

A chronic restraint stress (CRS) model was used to induce significant physiological and psychological stress in mice. Mice were subjected to 6 h of restraint daily in 50 mL plastic tubes for seven consecutive days. A fasting control group was included for comparison. Post-stress assessments included behavioural tests, glucose and insulin tolerance tests and indirect calorimetry. Blood and adipose tissue samples were collected for mRNA and protein analyses.

RESULTS

CRS induced significant psychological and physiological changes in mice, including depression-like behaviours, weight loss and reduced insulin sensitivity. Notably, CRS caused extensive adipose tissue remodelling. White adipose tissue (WAT) underwent significant 'browning' accompanied by an increase in the expression of thermogenic proteins. This counteracted the stress-induced 'whitening' of brown adipose tissue (BAT), which exhibited impaired thermogenesis and functionality, thereby maintaining energy balance systematically. The glucocorticoid receptor (GR) plays a crucial role in lipid metabolism regulation during these changes. GR expression levels were inversely correlated in BAT and WAT, but aligned with the expression patterns of thermogenic proteins across adipose tissues. These findings suggest that under chronic metabolic stress, GR mediates tissue-specific responses in adipose tissues, driving functional and phenotypic transitions in BAT and WAT to maintain energy homeostasis.

CONCLUSIONS

This study provides novel insights into the contrasting thermogenic phenotypes of BAT and WAT under emaciation and highlights the critical role of GRs in adipose tissue remodelling during CRS and its potential as a therapeutic target. Addressing GR-mediated changes in adipose tissues may help alleviate BAT dysfunction in cachexia and promote WAT browning, enhancing metabolic stress resistance.

Repurposing of nervous system drugs for cancer treatment: recent advances, challenges, and future perspectives

The nervous system plays a critical role in developmental biology and oncology, influencing processes from ontogeny to the complex dynamics of cancer progression. Interactions between the nervous system and cancer significantly affect oncogenesis, tumor growth, invasion, metastasis, treatment resistance, inflammation that promotes tumors, and the immune response. A comprehensive understanding of the signal transduction pathways involved in cancer biology is essential for devising effective anti-cancer strategies and overcoming resistance to existing therapies. Recent advances in cancer neuroscience promise to establish a new cornerstone of cancer therapy. Repurposing drugs originally developed for modulating nerve signal transduction represent a promising approach to target oncogenic signaling pathways in cancer treatment. This review endeavors to investigate the potential of repurposing neurological drugs, which target neurotransmitters and neural pathways, for oncological applications. In this context, it aims to bridge the interdisciplinary gap between neurology, psychiatry, internal medicine, and oncology. By leveraging already approved drugs, researchers can utilize existing extensive safety and efficacy data, thereby reducing both the time and financial resources necessary for the development of new cancer therapies. This strategy not only promises to enhance patient outcomes but also to expand the array of available treatments, thereby enriching the therapeutic landscape in oncology.

Health implications of established and emerging stressors: design of the prospective New Jersey Population Health Cohort (NJHealth) Study

INTRODUCTION

Some stressors, like the death of a partner, are common and rigorously studied, while others, such as those related to climate change or social media, are just emerging and in need of systematic research. The New Jersey Population Health Cohort (NJHealth) Study aims to characterise established and emerging stressors and delineate the pathways through which they influence health, especially among groups likely to experience chronic exposure to stressors including immigrants, people of colour, multigenerational families and low-income families.

METHODS AND ANALYSIS

A prospective cohort, the NJHealth Study is recruiting 8000 NJ residents aged 14 and older using probabilistic and purposive methods to include members of multigenerational families, marginalised racial/ethnic and low-income populations, and recent immigrant groups. Building on ecosocial, life course and stress process models, the NJHealth Study employs multimodal data collection to comprehensively measure stress-related factors at individual and societal levels. Interviews include self-assessments of individual and societal stressors, potential stress buffers and amplifiers, and health and well-being outcomes, including cognitive function, activity limitations and self-reported health. In addition, salivary DNA, fasting plasma, health assessments and actigraphy data are collected from selected participants; and existing electronic health records, health insurance claims, social service and employment data, and vital records are linked. NJ's socioeconomic and demographic diversity make it an exceptional setting for the study. Strong community and stakeholder engagement supports effective translation of research findings into practical policy and programme applications.

ETHICS AND DISSEMINATION

The study was approved by the WCGIRB (Study #1321099) (formerly Western IRB). Informed consent is obtained from participants for each source of participant-level data as well as linked administrative and clinical records. Findings will be reported to study participants, funding bodies, governmental and policy stakeholders, presented at scientific meetings and submitted for peer-review publication.

Ensuring equitable and affordable access to clean water for people living with cancer in a rural and coastal setting

BACKGROUND

The UN General Assembly (UNGA) stated that the right-to-water entitles everyone to accessible and affordable water. People living with cancer (PLWC) need water for numerous reasons including hydration, personal hygiene and infection control. In 2023, reports emerged of PLWC in Lincolnshire (UK) disconnecting their water supply from cost fears. We report on innovative ways to ease financial burden and provide equitable and affordable access to clean water for PLWC in rural and coastal settings.

METHODS

Quantitative data from secondary care and qualitative data from community-practitioners investigating PLWC's difficulties in accessing a clean and safe water supply were synthesised. A review of existing financial support identified no services directly addressing water. The Lincolnshire Living with Cancer Team approached water provider, Anglian Water sharing concerns, identifying common values, and confirming shared aims. A formal partnership was established to address these inequalities.

RESULTS

Initial data reviews showed completion of 25,858 Extra Care Assessments between Jan-Sept 2023 (12 % increase on previous year). This has enabled over 30,000 people with long-term conditions, including PLWC, to access clean and affordable water, a personalised support package for their water bill, including income maximisation, debt management, payment breaks, and bill reductions.

CONCLUSION

Impacts of cancer extend beyond physical health, with many PLWC reporting financial distress. Some PLWC have taken extreme measures to reduce their water consumption when they actually need increased water volumes. A partnership approach between health, voluntary and community sectors with a water provider can help address these inequalities.

POLICY SUMMARY

The study addresses national policy (NHS Long Term Plan 2019) by demonstrating how personalisation can be achieved for PLWC in a rural and coastal county. Internationally, it aligns to The European Code of Cancer Practice and seeks to contribute to its implementation UNGA Resolution 64/292, the universal human right to water and sanitation.

Psychiatric Comorbidities and Survival After Lobectomy for Stage I Non-Small Cell Lung Cancer

Background

The association between psychiatric comorbidities (PCs) and long-term survival after lobectomy for early-stage non-small cell lung cancer is unknown. We sought to investigate this relationship using the Surveillance, Epidemiology, & End-Results (SEER)-Medicare registry.

Methods

Data for all patients in the SEER-Medicare registry who underwent lobectomy for stage I non-small cell lung cancer from 2007 to 2014 were included. Those older than 80 years at time of diagnosis, with multiple cancers, or histology other than adenocarcinoma or squamous cell carcinoma were excluded. Patients diagnosed with depression, anxiety, bipolar disorder, schizophrenia, other (non-schizophrenic) psychotic disorders, unspecified mood disorder, attention-deficit/hyperactivity disorder, alcohol use disorder, or substance use disorder prior to lung cancer diagnosis were considered to have a PC. Survival of patients with PC was compared to controls using univariable and multivariable analysis adjusting for age, sex, race, stage (IA/IB), histology, surgical approach, and Charlson Comorbidity Index.

Results

Of 5516 patients, 1369 (24.8%) had PCs. Patients with PCs were more likely to be younger (P < .001), female (P < .001), white (P < .001), and have stage IA cancer (P < .001). PC was associated with shorter survival (median, 2478 vs 2820 days; P = .002). Multivariable analysis retained PC in the final model, with a hazard ratio of 1.10 (P < .001). Subgroup analysis revealed that this survival difference was driven by differences in survival of patients with schizophrenia (P < .001) and alcohol use disorder (P = .006).

Conclusions

Select psychiatric comorbidities are associated with reduced survival after lobectomy for early-stage non-small cell lung cancer.

Cardiovascular Disease and Cancer: A Dangerous Liaison

The field of cardio-oncology has traditionally focused on the impact of cancer and its therapies on cardiovascular health. Mounting clinical and preclinical evidence, however, indicates that the reverse may also be true: cardiovascular disease can itself influence tumor growth and metastasis. Numerous epidemiological studies have reported that individuals with prevalent cardiovascular disease have an increased incidence of cancer. In parallel, studies using preclinical mouse models of myocardial infarction, heart failure, and cardiac remodeling support the notion that cardiovascular disorders accelerate the growth of solid tumors and metastases. These findings have ushered in a new and burgeoning field termed reverse cardio-oncology that investigates the impact of cardiovascular disease pathophysiology on cancer emergence and progression. Recent studies have begun to illuminate the mechanisms driving this relationship, including shared risk factors, reprogramming of immune responses, changes in gene expression, and the release of cardiac factors that result in selective advantages for tumor cells or their local milieu, thus exacerbating cancer pathology. Here, we review the evidence supporting the relationship between cardiovascular disease and cancer, the mechanistic pathways enabling this connection, and the implications of these findings for patient care.

Dipeptidyl peptidase-4 deficiency prevents chronic stress-induced cardiac remodeling and dysfunction in mice

Exposure to chronic psychosocial stress is a risk factor for metabolic cardiovascular disorders. Dipeptidyl peptidase-4 (DPP-4) plays essential roles in human pathobiology, and we recently showed that DPP-4 levels are increased by chronic stress in murine models. We here investigated the role of DPP-4 in stress-related cardiac injury and dysfunction in mice, focusing on oxidative stress and cardiac apoptosis. Male mice were randomly assigned to non-stress and two-week immobilized-stress groups for biological and morphological studies. On day 14 post-stress, stress had increased blood pressure, heart weight, cardiac myocyte size, and interstitial fibrosis, impaired cardiac diastolic function, and increased plasma levels of DPP-4 and glucose. The stressed mice also had increased levels of monocyte chemoattractant protein-1, inteleukin-6, gp91phox, matrix metalloproteinase-2 (MMP-2), MMP-9, tissue inhibitor of MMP-1/-2, caspase-8, and Bax genes and/or proteins and lowered levels of Bcl-2, p-Akt, and endothelial nitric oxide synthase (eNOS) proteins. DPP-4 inhibition by either a genetic or pharmacological approach ameliorated the stress-induced targeted molecular and morphological changes. In vitro, DPP-4 inhibition also mitigated the alterations in the targeted caspase-8, Bcl-2, eNOS, and p-Akt proteins in H9c2 cardiomyocytes in response to H2O2. DPP-4 inhibition appeared to improve the stress-induced cardiac injury and dysfunction in mice, possibly via the improvement of oxidative stress and apoptosis, suggesting that DPP-4 could become a novel therapeutic target for chronic psychological stress-related metabolic cardiovascular disorders.

Gliadin-Rich Diet Worsens Immune and Redox Impairments in Prematurely Aging Mice

Gliadin is one of the most important fractions of gluten, a glycoprotein closely linked to the development of negative effects on physiological functions and the development of gastrointestinal diseases, such as celiac disease (CD). Research suggests that inadequate stress responses and anxiety states may trigger or at least contribute to the development of these pathological conditions. Peritoneal leukocytes from Prematurely Aging Mice (PAM), which are chronologically adult mice with compromised responses to stress and anxiety, exhibit functional changes when exposed in vitro to gliadin peptides, resembling some immune alterations found also in CD patients. This observation prompted us to investigate the effects of a gliadin-rich diet on immune function and redox state in PAM. In this study, adult female PAM were fed either a gluten-enriched diet (PAMD, 120 g/kg) or a standard diet (PAMC) for four weeks. Immune function parameters in peritoneal, splenic, and thymic leukocytes (phagocytosis, chemotaxis, Natural Killer activity, lymphoproliferation) and redox markers (glutathione reductase, glutathione peroxidase, reduced/oxidized glutathione, xanthine oxidase activity, lipid peroxidation) were evaluated. The results showed that PAMD exhibited more impaired immune function, lower antioxidant enzyme activities, and reduced glutathione concentrations, as well as higher oxidized glutathione and increased xanthine oxidase activity compared to PAMC. These findings suggest that a gliadin-rich diet worsens immune and redox impairments in PAM, resembling some of the alterations previously described in CD, and indicating the potential of this animal for studying gluten-induced immune dysregulation.

Caregiver burden and risk of epithelial ovarian cancer in the Nurses' Health Studies

Psychosocial stress may increase ovarian cancer risk and accelerate disease progression. We examined the association between caregiver burden, a common stressor, and risk of epithelial ovarian cancer. We prospectively followed 67 724 women in the Nurses' Health Study (1992-2012) and 70 720 women in the Nurses' Health Study II (2001-2009) who answered questions on informal caregiving (ie, caregiving outside of work). Women who reported no informal caregiving were considered noncaregivers, while, among women who provided care outside of work, caregiver burden was categorized by time spent caregiving and perceived stress from caregiving. For the 34% of women who provided informal care for ≥15 hours per week, 42% described caregiving as moderately to extremely stressful. Pooled multivariate analyses indicated no difference in ovarian cancer risk for women providing ≥15 hours of care per week compared to noncaregivers (hazard ratio [HR] = 0.96; 95% confidence interval [CI], 0.79-1.18), and no association was evident for women who reported moderate or extreme stress from caregiving compared to noncaregivers (HR = 0.96; 95% CI, 0.75-1.22). Together with prior work evaluating job strain and ovarian cancer risk, our findings suggest that, when evaluating a stressor's role in cancer risk, it is critical to consider how the stressor contributes to the overall experience of distress. This article is part of a Special Collection on Gynecological Cancer.

Dysbiotic oral microbiota-derived kynurenine, induced by chronic restraint stress, promotes head and neck squamous cell carcinoma by enhancing CD8+ T cell exhaustion

BACKGROUND

Chronic restraint stress (CRS) is a tumour-promoting factor. However, the underlying mechanism is unknown.

OBJECTIVE

We aimed to investigate whether CRS promotes head and neck squamous cell carcinoma (HNSCC) by altering the oral microbiota and related metabolites and whether kynurenine (Kyn) promotes HNSCC by modulating CD8+ T cells.

DESIGN

4-nitroquinoline-1-oxide (4NQO)-treated mice were exposed to CRS. Germ-free mice treated with 4NQO received oral microbiota transplants from either CRS or control mouse donors. 16S rRNA gene sequencing and liquid chromatography-mass spectrometry were performed on mouse saliva, faecal and plasma samples to investigate alterations in their microbiota and metabolites. The effects of Kyn on HNSCC were studied using the 4NQO-induced HNSCC mouse model.

RESULTS

Mice subjected to CRS demonstrated a higher incidence of HNSCC and oral microbial dysbiosis than CRS-free control mice. Pseudomonas and Veillonella species were enriched while certain oral bacteria, including Corynebacterium and Staphylococcus species, were depleted with CRS exposure. Furthermore, CRS-altered oral microbiota promoted HNSCC formation, caused oral and gut barrier dysfunction, and induced a host metabolome shift with increased plasma Kyn in germ-free mice exposed to 4NQO treatment. Under stress conditions, we also found that Kyn activated aryl hydrocarbon receptor (AhR) nuclear translocation and deubiquitination in tumour-reactive CD8+ T cells, thereby promoting HNSCC tumourigenesis.

CONCLUSION

CRS-induced oral microbiota dysbiosis plays a protumourigenic role in HNSCC and can influence host metabolism. Mechanistically, under stress conditions, Kyn promotes CD8+ T cell exhaustion and HNSCC tumourigenesis through stabilising AhR by its deubiquitination.

Exercise Interventions for Depression, Anxiety, and Quality of Life in Older Adults With Cancer: A Systematic Review and Meta-Analysis

Importance

Cancer and its treatment negatively impact the mental health of older adults. The potential of exercise interventions as a complementary treatment to alleviate the psychological impacts of cancer is promising, but there are gaps in the current literature.

Objective

To determine if exercise interventions are associated with improvements in psychological outcomes among older adults with cancer.

Data Sources

PubMed, Embase, PsycINFO, and Cochrane databases were searched from database inception to November 5, 2024. Search terms used were geriatrics, cancer, depression, anxiety, quality of life, and exercise interventions.

Study Selection

English-language randomized clinical trials (RCTs) that analyzed the association of various exercise interventions with at least 1 of 3 psychological outcomes (depression, anxiety, or health-related quality-of-life [HRQOL]) were included. The control groups were given usual care. Studies were included if the mean age of participants was older than 60 years and had participants with a diagnosis of any cancer regardless of comorbidities.

Data Extraction and Synthesis

Studies were screened, and data were extracted by 2 independent authors. Random-effects meta-analyses and meta-regressions were used for analysis. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline was followed.

Main Outcomes and Measures

The primary outcomes were depression, anxiety, and HRQOL. Standardized mean difference (SMD) was used to quantify the association of exercise interventions with outcomes.

Results

A total of 27 RCTs with 1929 participants were included. Meta-analyses observed an association of exercise with a significant reduction in levels of depression (SMD = -0.53; 95% CI, -0.79 to -0.28) and anxiety (SMD = -0.39; 95% CI, -0.66 to -0.12) and improvements in overall HRQOL (SMD = 0.63; 95% CI, 0.10 to 1.17). Subgroup analyses revealed that mind-body exercise interventions were significantly associated with improved depression (SMD = -0.89; 95% CI, -1.51 to -0.27) and anxiety levels (SMD = -0.77; 95% CI, -1.54 to -0.01) compared with conventional exercise interventions.

Conclusion

In this systematic review and meta-analysis of 27 RCTs, exercise interventions were found to be associated with significantly reduced levels of depression and anxiety and significantly improved HRQOL in older adults with cancer. These findings suggest that health care professionals and policymakers should focus more on implementing exercise interventions to improve mental health outcomes in this vulnerable population.

Diminished salivary cortisol response to mental stress predict all-cause mortality in general population

OBJECTIVES

To characterize individuals with a diminished salivary cortisol response to mental stress, assess its association with all-cause mortality, and quantify the mediating effects of the most relevant and modifiable factors to identify potential target for prevention.

METHODS

Data from MIDUS II study with a 16-year follow-up, were used to categorize 1129 participants as responders or non-responders based on the existence of increase in salivary cortisol under mental stress. LASSO-logistics analysis identified the most relevant factors. Cox regression models and restricted cubic splines evaluated the prognostic impact. Further analyses examined the mediating effects of identified factors on prognosis.

RESULTS

After employing Inverse Probability of Treatment Weighting to adjust for demographic differences between groups, individuals with diminished cortisol responses were found to have higher levels of depressive symptoms (p = 0.050), increased inflammation (IL-6, 2.30 [1.41, 3.79] vs. 1.96[1.33, 3.31], p = 0.011), and were less likely to regularly exercise (74.3 % vs. 79.9 %, p = 0.030). IL-6 (OR: 1.25 [1.04, 1.52]，p = 0.021) and regularly exercising (OR 0.71 [0.51, 0.97], p = 0.032) emerged as significant modifiable factors in multivariate analysis. A notable prognostic association of diminished cortisol response with all-cause mortality (HR = 1.33 [1.01-1.76], p = 0.046) was observed, consistent across various subgroups and supported by non-linear model analysis. Approximately 13 % of the mortality risk associated with diminished cortisol response was mediated by increased IL-6 levels (p = 0.043).

CONCLUSION

Diminished salivary cortisol response is linked to an increased risk of all-cause mortality, significantly mediated by elevated IL-6. This study offers a new perspective on prognostic prediction while highlighting potential avenues for intervention.

Clinicopathological Analysis of Oral Paracoccidioidomycosis in Women

Paracoccidioidomycosis (PCM) is a deep systemic mycosis caused by Paracoccidioides brasiliensis. PCM affects predominantly men in their fifth and sixth decades of life, with low prevalence in women. The reasons for this discrepancy are not fully understood, but oestrogen may influence the transformation of the fungus and modulate the immune response.

OBJECTIVE

To describe and correlate the clinical and histopathological characteristics of oral PCM in women.

MATERIAL AND METHODS

This study analysed 45 cases of oral PCM in women, collecting clinical data such as age, smoking and alcohol consumption habits, pain, lesion location, duration of symptoms, presence of unique or multifocal lesions, as well as associated findings such as skin lesions, lymphadenopathy and systemic alterations. Additionally, histopathological characteristics were examined, including the presence of fungi, the quantity of multinucleated giant cells and the presence of well-organised granulomas, non-granulomatous areas, microabscesses and pseudoepitheliomatous hyperplasia. All data were recorded, tabulated and subjected to statistical analysis. Fungal quantification in the analysed slides was performed using the QuPath software, counting each fungal structure and analysing it based on the calculated specimen area.

RESULTS

The average age of patients was 44.18 years (range: 20-68 years). Over half (53.3%) were smokers and 20% were alcoholics. Most lesions were multifocal (51%), with the alveolar ridge being the most commonly affected site, and pain was reported by 68.89% of the patients. Histopathologically, 33.33% of lesions had a low count of visible fungi per square millimetre, 37.78% had a moderate count and 28.89% had a high count. Most lesions (82.22%) contained many multinucleated giant cells, 55.56% had well-organised granulomas, 75.56% presented with microabscesses and 88.89% showed pseudoepitheliomatous hyperplasia.

CONCLUSION

Despite its rarity in women, PCM has similar clinical and histopathological features compared to those in men and should be considered in the differential diagnosis of unique and multifocal ulcerated lesions.

Exploring the complex relationship between psychosocial stress and the gut microbiome: implications for inflammation and immune modulation

There is growing interest in understanding the complex relationship between psychosocial stress and the human gastrointestinal microbiome (GIM). This review explores the potential physiological pathways connecting these two and how they contribute to a proinflammatory environment that can lead to the development and progression of the disease. Exposure to psychosocial stress triggers the activation of the sympathetic nervous system (SNS) and hypothalamic-pituitary axis (HPA), leading to various physiological responses essential for survival and coping with the stressor. However, chronic stress in susceptible individuals could cause sustained activation of HPA and SNS, leading to immune dysregulation consisting of redistribution of natural killer (NK) cells in the bloodstream, decreased function of T and B cells, and elevation of proinflammatory cytokines such as interleukin-1, interleukin-6, tumor necrotic factor-α, interferon-gamma. It also leads to disruption of the GIM composition and increased intestinal barrier permeability, contributing to GIM dysbiosis. The GIM dysbiosis and elevated cytokines can lead to reciprocal effects and further stimulate the HPA and SNS, creating a positive feedback loop that results in a proinflammatory state underlying the pathogenesis and progression of stress-associated cardiovascular, gastrointestinal, autoimmune, and psychiatric disorders. Understanding these relationships is critical for developing new strategies for managing stress-related health disorders.

Ansofaxine suppressed NSCLC progression by increasing sensitization to combination immunotherapy

INTRODUCTION

Depression negatively impacts the prognosis of various cancers, including lung cancer, by influencing antitumor immune responses and impairing immune cell function. Antidepressants may modulate the tumor immune microenvironment, enhancing immunotherapy efficacy. However, the specific mechanisms remain unclear. This study investigates the effects of the antidepressant Ansofaxine on immune therapy in non-small cell lung cancer (NSCLC) mice with comorbid depression.

METHODS

Chronic unpredictable mild stress (CUMS) and Lewis lung cancer cells (LLC) model was established in mice. Ansofaxine and a combination of triple immunotherapy (anti-PD-1, anti-TNFR2, and anti-PTP1B) were treated in mice to monitor tumor growth and survival rates. Flow cytometry and immunohistochemistry were employed to analyze the dynamics of the immune system, while ELISA kits were used to quantify neurotransmitter levels.

RESULTS

Depression accelerated NSCLC progression, evidenced by increased tumor volume, spleen size, and reduced survival rates. Flow cytometry analysis demonstrated a reduction in the population of immune effector cells, with an increase in the proportion of immunosuppressive cells. Ansofaxine inhibited LLC cell proliferation and migration, enhancing apoptosis more effectively than venlafaxine and fluoxetine. Combined with triple immunotherapy, Ansofaxine improved survival rates and enhanced immune responses, increasing CD8+ T cell proportions and decreasing Tregs. Ansofaxine also restored serum serotonin and norepinephrine levels in depressed mice, reduced corticosterone, and decreased PD-L1 and TNFR2 expression in tumor tissues.

CONCLUSION

The findings suggest that Ansofaxine may represent a promising therapeutic approach for NSCLC patients with comorbid depression, potentially enhancing both mental well-being and cancer-related outcomes.

Neuroscience of cancer: unraveling the complex interplay between the nervous system, the tumor and the tumor immune microenvironment

The study of the multifaceted interactions between neuroscience and cancer is an emerging field with significant implications for understanding tumor biology and the innovation in therapeutic approaches. Increasing evidence suggests that neurological functions are connected with tumorigenesis. In particular, the peripheral and central nervous systems, synapse, neurotransmitters, and neurotrophins affect tumor progression and metastasis through various regulatory approaches and the tumor immune microenvironment. In this review, we summarized the neurological functions that affect tumorigenesis and metastasis, which are controlled by the central and peripheral nervous systems. We also explored the roles of neurotransmitters and neurotrophins in cancer progression. Moreover, we examined the interplay between the nervous system and the tumor immune microenvironment. We have also identified drugs that target the nervous system for cancer treatment. In this review we present the work supporting that therapeutic agent targeting the nervous system could have significant potential to improve cancer therapy.

A genetic exploration of the relationship between posttraumatic stress disorder and cardiovascular diseases

Experiencing a traumatic event may lead to Posttraumatic Stress Disorder (PTSD), including symptoms such as flashbacks and hyperarousal. Individuals suffering from PTSD are at increased risk of cardiovascular disease (CVD), but it is unclear why. This study assesses shared genetic liability and potential causal pathways between PTSD and CVD. We leveraged summary-level data of genome-wide association studies (PTSD: N = 1,222,882; atrial fibrillation (AF): N = 482,409; coronary artery disease (CAD): N = 1,165,690; hypertension (HT): N = 458,554; heart failure (HF): N = 977,323). First, we estimated genetic correlations and utilized genomic structural equation modeling to identify a common genetic factor for PTSD and CVD. Next, we assessed biological, behavioural, and psychosocial factors as potential mediators. Finally, we employed multivariable Mendelian randomization to examine causal pathways between PTSD and CVD, incorporating the same potential mediators. Significant genetic correlations were found between PTSD and CAD, HT, and HF (rg = 0.21-0.32, p ≤ 3.08 · 10-16), but not between PTSD and AF. Insomnia, smoking, alcohol dependence, waist-to-hip ratio, and inflammation (IL6, C-reactive protein) partly mediated these associations. Mendelian randomization indicated that PTSD causally increases CAD (IVW OR = 1.53, 95% CIs = 1.19-1.96, p = 0.001), HF (OR = 1.44, CIs = 1.08-1.92, p = 0.012), and to a lesser degree HT (OR = 1.25, CIs = 1.05-1.49, p = 0.012). While insomnia, smoking, alcohol, and inflammation were important mediators, independent causal effects also remained. In addition to shared genetic liability between PTSD and CVD, we present strong evidence for causal effects of PTSD on CVD. Crucially, we implicate specific lifestyle and biological mediators (insomnia, substance use, inflammation) which has important implications for interventions to prevent CVD in PTSD patients.

Effectiveness of meaning-centered interventions on anxiety and depressive symptoms, sense of meaning, and quality of life in patients with advanced cancer: a meta-analysis of randomized controlled trials

OBJECTIVE

The effect of Meaning-Centered Interventions (MCI) in advanced cancer patients requires further comprehensive research.

METHODS

Two researchers independently searched the PubMed, EMBASE, SCOPUS, Cochrane, and PsycINFO databases to investigate the impact of MCI on anxiety and depressive symptoms, sense of meaning, and quality of life (QoL) in patients with advanced cancer from inception to April 2024. Statistical analyses were conducted using standardized mean difference (SMD) as the effect size with Stata 17.0 software for analysis, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was employed to assess the certainty of evidence.

RESULTS

Data from 12 eligible studies, involving a total of 1,459 participants, were included in the review. The analysis found that 3 studies with 321 participants reported an improvement in the quality of life (QoL) of patients with advanced cancer within one month after the intervention, compared to the control group (SMD, 0.27; 95% CI, 0.03 to 0.52; I2 = 0%; p = 0.03). However, this effect did not persist during the 2-6 months following the intervention. In addition, 4 studies with 434 participants indicated that MCI was associated with an enhanced sense of meaning (SMD, 0.22; 95% CI, 0.09 to 0.36; I2 = 0%; p = 0.002). Furthermore, 8 studies with 1,192 participants and 7 studies with 1,156 participants found that MCI was associated with a reduction in depressive symptoms (SMD, -0.15; 95% CI, -0.24 to -0.05; I2 = 44.8%; p = 0.002) and anxiety symptoms (SMD, -0.16; 95% CI, -0.26 to -0.07; I2 = 46.3%; p = 0.001), respectively.

CONCLUSIONS

Moderate-quality evidence indicates that MCI enhances the sense of meaning among patients with advanced cancer and reduces depressive and anxiety symptoms, but it does not improve their QoL.

Mental Health Disparities by Sexual Orientation and Gender Identity in the All of Us Research Program

Importance

Limited research explores mental health disparities between individuals in sexual and gender minority (SGM) populations and cisgender heterosexual (non-SGM) populations using national-level data.

Objective

To explore mental health disparities between SGM and non-SGM populations across sexual orientation, sex assigned at birth, and gender identity within the All of Us Research Program.

Design, Setting, and Participants

This cross-sectional study used survey data and linked electronic health records of eligible All of Us Research Program participants from May 31, 2017, to June 30, 2022.

Exposure

Self-identified SGM status.

Main Outcomes and Measures

Prevalence of common mental health conditions identified from linked electronic health records. Logistic regression adjusted for age, race and ethnicity, educational level, income, employment status, and geographic region was used to assess the association between SGM status and mental health conditions.

Results

Among 413 457 participants, 269 947 (65.3%) were included in the analysis (median age, 59 [IQR, 43-70] years), with 22 189 (8.2%) self-identified as SGM. Men with cisgender sexual minority identity had higher odds of bipolar disorder (adjusted odds ratio [AOR], 1.87; 95% CI, 1.70-2.56) compared with cisgender heterosexual men. Women with cisgender sexual minority identity had higher odds of bipolar disorder (AOR, 2.09; 95% CI, 1.95-2.25) compared with cisgender heterosexual women. Gender diverse people assigned female sex at birth had higher odds of posttraumatic stress disorder (PTSD) compared with both cisgender heterosexual men (AOR, 3.67; 95% CI, 2.99-4.50) and cisgender heterosexual women (AOR, 2.77; 95% CI, 2.26-3.40). Gender diverse individuals assigned male sex at birth had higher odds of bipolar disorder (AOR, 2.35; 95% CI, 1.66-3.33) compared with cisgender heterosexual men and higher odds of attention-deficit/hyperactivity disorder (AOR, 2.19; 95% CI, 1.48-3.23) compared with cisgender heterosexual women. Transgender men had higher odds of depression (AOR, 2.11; 95% CI, 1.80-2.49) compared with cisgender heterosexual men, while transgender women had higher odds of any personality disorder (AOR, 2.71; 95% CI, 1.84-3.99) compared with cisgender heterosexual women.

Conclusions and Relevance

In this cross-sectional study of participants in the All of Us Research Program, there were significant mental health disparities between participants in SGM and non-SGM groups. These findings underscore the need for tailored mental health interventions to improve the well-being of SGM populations, while noting that the associations do not imply causality but reflect the stigma and minority stress experienced by these individuals.

The Contribution of Noncommunicable and Infectious Diseases to the Effect of Depression on Mortality: A Longitudinal Causal Mediation Analysis

BACKGROUND

The increased prevalence of physical diseases among individuals with mental illness contributes to their increased risk of mortality. However, the mediating role of specific diseases in the effect of mental illness on mortality is not well understood.

METHOD

We conducted a longitudinal causal mediation analysis using data from beneficiaries of a South African medical insurance scheme from 2011 to 2020. We estimated the overall effect of major depressive disorder (MDD) on mortality and evaluated reductions in this overall effect through hypothetical interventions on the risks of mediating physical diseases using an interventional effects approach. Monte Carlo simulation-based g-computation was used for estimation.

RESULTS

Among 981,540 individuals, 143,314 (14.6%) were diagnosed with MDD. Mortality risk after 8 years was 6.5% under MDD, and 5.3% under no MDD (risk ratio 1.23, 95% CI = 1.19, 1.26). Overall, 43.4% of this disparity could be attributed to higher rates of physical comorbidities due to MDD. Cardiovascular diseases accounted for 17.8%, followed by chronic respiratory diseases (8.6%), cancers (7.5%), diabetes and chronic kidney disease (5.8%), tuberculosis (4.3%), and HIV (2.7%).

CONCLUSION

Within the privately insured population of South Africa, MDD is associated with increased mortality. We found that noncommunicable diseases, rather than infectious diseases, are important mediators of the effect of MDD on mortality.

Analysis of Germinal Center Reaction in Competitive Bone Marrow Chimeric Rag2-/-γc-/-Mice

Germinal center (GC) reaction is crucial for the generation of high-affinity antibodies against any infection. To address the role of specific genes in GC, knockout mouse models are generally used. However, since GC is a multicellular event, complete knockout models cannot pinpoint the cell-intrinsic effect of certain genes in GC reaction. Here, we describe a detailed protocol for the analysis of GC in competitive bone marrow (BM) chimeric mice generated by transplanting 1:1 mixture of CD45.1 and CD45.2 positive donor bone marrow (BM) cells in immunodeficient Rag2-/-γc-/- mice as recipient host. We describe the method of immunization using sheep red blood cells (SRBC), detection of successful immunization by the antigen-specific antibody titer in the serum of the immunized mice and finally assessing the GC reaction in the spleen of the immunized mice by flow cytometry 10 days post-immunization. When the competitive chimera is made with wild type (WT) and a knockout (KO) donor BM, this method is suitable to address the cell type-specific (e.g., B-cell specific) role of the KO gene in GC.

fMRI used to observe the acute craniocerebral response of esophageal cancer related depressive patients treated by rTMS: Initial experience

To observe the immediate craniocerebral response, changes of spontaneous nerve activity and functional connection after repeated transcranial magnetic stimulation (rTMS) in esophageal cancer patients with depression (ECPD) by functional magnetic resonance imaging (fMRI), and to explore the therapeutic effect, neuroactivity response and mechanism. Eleven patients with ECPD were enrolled to treated with single rTMS. The patients were examined by fMRI before and after the treatment. The changes of low frequency amplitude (ALFF) and the functional connection network between different brain regions of ALFF in patients were compared before and after rTMS treatment. Compared with those before rTMS treatment, the Hamilton Depression Rating Scale (HAMD) score decreased significantly after rTMS treatment (t = -7.63, P = .0001). The ALFF of bilateral putamen, left thalamus, left posterior cingulate gyrus and right middle temporal gyrus decreased significantly (P = .02). In addition, the functional connection between the cortex-limbic system-striatum-thalamus nerve loop increased in patients after rTMS treatment. rTMS may achieve the effect of rehabilitation treatment by improving the spontaneous neural activity and regulating the neural connection network of cortical-limbic systems-triatum-thalamus loop in ECPD.

Vasopressin drives aberrant myeloid differentiation of hematopoietic stem cells, contributing to depression in mice

Psychological stress is often linked to depression and can also impact the immune system, illustrating the interconnectedness of mental health and immune function. Hematopoietic stem cells (HSCs) can directly sense neuroendocrine signals in bone marrow and play a fundamental role in the maintenance of immune homeostasis. However, it is unclear how psychological stress impacts HSCs in depression. Here, we report that neuroendocrine factor arginine vasopressin (AVP) promotes myeloid-biased HSC differentiation by activating neutrophils. AVP administration increases neutrophil and Ly6Chi monocyte production by triggering HSCs that rely on intrinsic S100A9 in mice. When stimulated with AVP, neutrophils return to the bone marrow and release interleukin 36G (IL-36G), which interacts with interleukin 1 receptor-like 2 (IL-1RL2) on HSCs to produce neutrophils with high Elane expression that infiltrate the brain and induce neuroinflammation. Together, these findings define HSCs as a relay between psychological stress and myelopoiesis and identify the IL-36G-IL-1RL2 axis as a potential target for depression therapy.

Symptom improvements and adverse effects with Reishi mushroom use: A Cross-Sectional survey of cancer patients

Background

Reishi, a medicinal mushroom, is increasingly used for symptom control by cancer patients worldwide. However, data around patients' experiences with Reishi in oncology are lacking, limiting safe, effective clinical applications. We thus sought to evaluate patient reported benefits and harms of using Reishi.

Methods

We conducted a cross-sectional survey among Chinese cancer patients using Reishi products, probing for symptom improvements and/or adverse events (AEs) after taking Reishi. Multivariable logistic regression models assessed whether socio-demographic or clinical factors, as well as duration of Reishi use or combination with other TCM herbs, were associated with being a "responder" - reporting "quite a bit" or "very much" symptom improvement.

Results

Among 1374 participants, more than half of participants reported that nausea (55 %), fatigue (52 %), poor appetite (51 %), and depression (50 %) improved quite a bit or very much after taking Reishi. In multivariate analyses, age <65 years (adjusted odds ratios [AOR] = 1.76, p = 0.001), diagnosis ≥ 10 years (AOR = 1.78, p = 0.018), and duration of Reishi use ≥ 1 year (1-3 years: AOR = 1.53, p = 0.045; 3-5 years: AOR = 2.04, p = 0.001; >5 years: AOR = 2.07, p < 0.001) were significantly associated with higher responder rates for symptom improvement. However, 125 (9.1 %) also reported a range of AEs, including dry mouth (5 %), constipation (4 %), insomnia (3 %), pruritus (3 %) and vertigo (3 %).

Conclusion

While majority of cancer patients using Reishi reported symptom improvements, some reported adverse effects. This information can assist clinicians in advising cancer patients on safe and effective use of Reishi and help identify specific outcomes for assessment in future prospective clinical trials.

Causal relationship between affect disorders and endometrial cancer: a Mendelian randomisation study

BACKGROUND

The aim was to assess the causal relationship between depression and anxiety disorders and endometrial cancer.

METHOD

We performed two-sample Mendelian randomisation analysis using summary statistics from genome-wide association studies to assess associations of major depressive disorder, anxiety and stress-related disorders with endometrial cancer. The genome-wide association studies(GWASs) data were derived from participants of predominantly European ancestry included in the Genome-wide Association Research Collaboration. Inverse variance-weighted, MR-Egger and weighted median MR analyses were performed, together with a range of sensitivity analyses.

RESULTS

Mendelian randomisation analysis showed no statistically significant genetic responsibility effect of anxiety and stress-related disorders on any pathological type of endometrial cancer. Only the effect of major depressive disorder under the inverse variance weighting method increasing the risk of endometrial endometrial cancer (effect 0.004 p = 0.047) and the effect of major depressive disorder under the MR-Egger method decreasing endometrial cancer of all pathology types (effect -0.691 p = 0.015) were statistically significant. Other Mendelian randomisation analyses did not show a statistically significant effect.

CONCLUSION

Major depressive disorder(MDD), anxiety and stress-related disorders(ASRD) are not genetically responsible for endometrial cancer. We consider that emotional disorders may affect endometrial cancer indirectly by affecting body mass index. This study provides us with new insights to better understand the aetiology of endometrial cancer and inform prevention strategies.

Translational Approach to Social Isolation During a Global Pandemic: Hippocampal Somatic Mutation and Stress

OBJECTIVE

The coronavirus disease-2019 (COVID-19) pandemic's social isolation has significantly impacted mental health, increasing depression and anxiety. This study explores the effects of social isolation on both humans and mice, focusing on behavioral changes and hippocampal protein expression. It also investigates genetic alterations through single-cell RNA and whole-genome sequencing (WGS).

METHODS

Here we conducted behavioral studies, protein expression studies, single-nucleus sequencing (snRNAseq), and WGS of the hippocampus of mice that underwent early maternal separation and social isolation, and a demographic study of community populations who had been self-quarantined owing to COVID-19 exposure to investigate the link between somatic mutations and stress due to social isolation.

RESULTS

The demographic study demonstrated more negative mental health findings among individuals who live alone or are single. Mice subjected to early maternal separation and social isolation demonstrated increased anxiety-like behaviors and stress-related corticotropin-releasing hormone receptor 1, and neurogenesis-related sex-determining region Y-box 2 and doublecortin expression. In snRNA-seq, differences, such as transthyretin increase, were observed in the maternal separation group, and somatic mutations, including insertion in the intron site of Tmem267, were observed in the social isolation group on WGS.

CONCLUSION

The results of this study suggest that stress, such as social isolation, can cause changes at the genetic level, as well as behavioral and brain protein changes.

A brain-to-liver signal mediates the inhibition of liver regeneration under chronic stress in mice

As the ability of liver regeneration is pivotal for liver disease patients, it will be of high significance and importance to identify the missing piece of the jigsaw influencing the liver regeneration. Here, we report that chronic stress impairs the liver regeneration capacity after partial hepatectomy with increased mortality in male mice. Anatomical tracing and functional mapping identified a neural circuit from noradrenergic neurons in the locus coeruleus (LC) to serotonergic neurons in the rostral medullary raphe region (rMR), which critically contributes to the inhibition of liver regeneration under chronic stress. In addition, hepatic sympathetic nerves were shown to be critical for the inhibitory effects on liver regeneration by releasing norepinephrine (NE), which acts on adrenergic receptor β2 (ADRB2) to block the proinflammatory macrophage activation. Collectively, we reveal a "brain-to-liver" neural connection that mediates chronic stress-evoked deficits in liver regeneration, thus shedding important insights into hepatic disease therapy.

Deeply Saddening Life Events Play a Carcinogenic Role by Inducing Mutations in ALOX12 and FKBP5 Genes

BACKGROUND/OBJECTIVES

In the past few decades, many studies have been conducted to find out that psychological stress and cancer are closely linked. Moreover, it was reported that stress can induce mutations in gene level. Therefore, in this study we want to examine a relationship between stressful life events, gene mutation and cancer.

METHODS

Stressful Life Experiences Screening (SLES), Hospital Anxiety and Depression Scale (HADS) and the Coping with Stress Style Scale (CSS) were applied to the participants to examine relationship between stress and cancer.

RESULTS

NGS results showed higher level of mutations accumulated on FKBP5 and ALOX12 genes in cancer patients who were exposed to stressful life events. The expression status of ALOX12 and FKBP5 genes on patients with or without cancer and several cancer cell lines demonstrated that both ALOX12 and FKBP5 mRNA levels were downregulated only in cancer patients and cancer cell lines but not in cancer free control groups. Re-created overexpression of the WT-ALOX12 and WT-FKBP5 extremely inhibited cellular growth, cellular invasion in cancer cell lines, tumor growth in xenograft model too.

CONCLUSIONS

Our results indicate that Stressful Life Experiences may induce cancer development by increased somatic mutations in ALOX12 and FKBP5 genes.

Marital status as an independent prognostic factor for survival in women with vaginal cancer: evidence from the SEER database analysis

This study aimed to evaluate the influence of marital status on the survival outcomes of women diagnosed with vaginal cancer, considering the potential role of sociodemographic factors in patient prognosis. Utilizing data from the Surveillance, Epidemiology, and End Results database, the study included 6046 women with primary vaginal cancer diagnosed between 2000 and 2020. The propensity score matching (PSM) method was employed to balance comparison groups and account for confounding factors. The primary outcomes were overall survival (OS) and cancer-specific survival (CSS), with Cox proportional-hazards regression models used for statistical analysis. Married patients exhibited better survival outcomes than their unmarried counterparts [OS: hazard ratio = 1.520, 95% confidence interval (CI) = 1.430-1.630, P < 0.001; CSS: hazard ratio = 1.380, 95% CI = 1.270-1.490, P < 0.001]. Subgroup analyses stratified by age and race highlighted a significant survival benefit for married individuals, particularly those aged 50-69 years and white patients. After PSM, the widowed subgroup within the unmarried category showed worse survival outcomes (OS: hazard ratio = 1.580, 95% CI = 1.430-1.750, P < 0.001; CSS: hazard ratio = 1.360, 95% CI = 1.200-1.530, P < 0.001). This study demonstrates that marital status serves as an independent prognostic factor for OS and CSS among patients with primary vaginal cancer, which supports that unmarried people need more individualized care strategies.

Neural Circuitries between the Brain and Peripheral Solid Tumors

The recent discovery of the pivotal role of the central nervous system in controlling tumor initiation and progression has opened a new field of research. Increasing evidence suggests a bidirectional interaction between the brain and tumors. The brain influences the biological behavior of tumor cells through complex neural networks involving the peripheral nervous system, the endocrine system, and the immune system, whereas tumors can establish local autonomic and sensory neural networks to transmit signals into the central nervous system, thereby affecting brain activity. This review aims to summarize the latest research in brain-tumor cross-talk, exploring neural circuitries between the brain and various peripheral solid tumors, analyzing the roles in tumor development and the related molecular mediators and pathologic mechanisms, and highlighting the critical impact on the understanding of cancer biology. Enhanced understanding of reciprocal communication between the brain and tumors will establish a solid theoretical basis for further research and could open avenues for repurposing psychiatric interventions in cancer treatment.

Assessing last month's stress levels with an automated facial behavior scan

Stress is one of the most pressing problems in society as it severely reduces the physical and mental wellbeing of people. It is therefore of great importance to accurately monitor stress levels, especially in work environments. However, contemporary stress assessments, such as questionnaires and physiological measurements, have practical limitations, mostly related to their subjective or contact-based nature. To assess stress objectively and conveniently, we developed an automated model that detects biomarkers in webcam-recorded facial behavior indicative of heightened stress levels, using computer vision, artificial intelligence, and machine learning techniques. Heart-rate induced skin pulsations and facial muscle activity were extracted from videos of 264 participants that performed an online mental capacity test under considerable time pressure. The model could successfully use these facial biomarkers to explain a significant proportion of individual differences in scores on a self-perceived stress scale. Next, we used the model to objectively score stress levels of 63 military candidates (pre-hiring) and 69 military personnel (post-hiring) that also performed the mental capacity test. Results showed that military personnel expressed facial behavior indicative of significantly higher stress levels than military candidates. This suggests that joining the military heightens overall stress levels. With this study we take the first steps towards a non-contact, automated, and objective measure of stress that is easily applicable in a variety of health and work contexts.

Diabetes and obesity: the role of stress in the development of cancer

Diabesity is a condition where an individual has both diabetes and obesity, which can lead to severe complications including cardiovascular disease, a leading cause of mortality. Recently, cancer has become a leading cause of excess hospitalizations, and both diabetes and obesity are associated with a higher risk of developing several types of cancer. In this review, we propose that chronic stress significantly increases this association. Managing diabetes and obesity is challenging as they both cause significant distress. The relationship between stress and cancer is interconnected, with anxiety and depression being common in cancer patients. Cancer diagnosis and treatment can cause lasting changes in the body's neuroendocrine system, with stress causing an excessive release of catecholamines and prostaglandins in patients undergoing cancer surgery, which promotes the spread of cancer to other parts of the body. Furthermore, stress could significantly increase the risk of cancer in patients with diabetes, obesity, or both.

Microbiota-immune-brain interactions: A new vision in the understanding of periodontal health and disease

This review highlights the significance of interactions between the microbiota, immune system, nervous and hormonal systems, and the brain on periodontal health and disease. Microorganisms in the microbiota, immune cells, and neurons communicate via homeostatic nervous and hormonal systems, regulating vital body functions. By modulating pro-inflammatory and anti-inflammatory adaptive immune responses, these systems control the composition and number of microorganisms in the microbiota. The strength of these brain-controlled responses is genetically determined but is sensitive to early childhood stressors, which can permanently alter their responsiveness via epigenetic mechanisms, and to adult stressors, causing temporary changes. Clinical evidence and research with humans and animal models indicate that factors linked to severe periodontitis enhance the responsiveness of these homeostatic systems, leading to persistent hyperactivation. This weakens the immune defense against invasive symbiotic microorganisms (pathobionts) while strengthening the defense against non-invasive symbionts at the gingival margin. The result is an increased gingival tissue load of pathobionts, including Gram-negative bacteria, followed by an excessive innate immune response, which prevents infection but simultaneously destroys gingival and periodontal tissues. Thus, the balance between pro-inflammatory and anti-inflammatory adaptive immunity is crucial in controlling the microbiota, and the responsiveness of brain-controlled homeostatic systems determines periodontal health.

Cortisol affects macrophage polarization by inducing miR-143/145 cluster to reprogram glucose metabolism and by promoting TCA cycle anaplerosis

Chronic stress can have adverse consequences on human health by disrupting the hormonal balance in our body. Earlier, we observed elevated levels of cortisol, a primary stress hormone, and some exosomal microRNAs in the serum of patients with breast cancer. Here, we investigated the role of cortisol in microRNA induction and its functional consequences. We found that cortisol induced the expression of miR-143/145 cluster in human monocyte (THP1 and U937)-derived macrophages but not in breast cancer cells. In silico analysis identified glucocorticoid-response element in the upstream CARMN promoter utilized by the miR-143/145 cluster. Enhanced binding of glucocorticoid-receptor (GR) upon cortisol exposure and its regulatory significance was confirmed by chromatin-immunoprecipitation and promoter-reporter assays. Further, cortisol inhibited IFNγ-induced M1 polarization and promoted M2 polarization, and these effects were suppressed by miR-143-3p and miR-145-5p inhibitors pretreatment. Cortisol-treated macrophages exhibited increased oxygen-consumption rate (OCR) to extracellular-acidification rate (ECAR) ratio, and this change was neutralized by functional inhibition of miR-143-3p and miR-145-5p. HK2 and ADPGK were confirmed as the direct targets of miR-143-3p and miR-145-5p, respectively. Interestingly, silencing of HK2 and ADPGK inhibited IFNγ-induced M1 polarization but failed to induce M2 polarization, since it suppressed both ECAR and OCR, while OCR was largely sustained in cortisol-treated M2-polarized macrophages. We found that cortisol treatment sustained OCR by enhancing fatty acid and glutamine metabolism through upregulation of CPT2 and GLS, respectively, to support M2 polarization. Thus, our findings unfold a novel mechanism of immune suppression by cortisol and open avenues for preventive and therapeutic interventions.

Causality between neuroticism personality clusters and female reproductive diseases in European population: a two-sample bidirectional mendelian randomization study

BACKGROUND

The causality between neuroticism, a personality trait characterized by the tendency to experience negative emotions, and female reproductive diseases remains unclear. To provide evidence for the development of effective screening and prevention strategies, this study employed Mendelian randomization (MR) to investigate the causality between neuroticism clusters and female reproductive diseases.

METHODS

Instrumental variables were obtained from large-scale genome-wide association studies of populations of European descent involving three neuroticism clusters (depressed affect, worry, sensitivity to environmental stress, and adversity [SESA]) in the Complex Trait Genetics database and six female reproductive diseases (infertility, polycystic ovary syndrome [PCOS], spontaneous abortion, recurrent spontaneous abortion, endometriosis, and uterine fibroids) in the FinnGen database. The bidirectional two-sample MR analysis was conducted using the inverse variance-weighted, weighted median, and MR-Egger methods, whereas the sensitivity analysis was conducted using the Cochran's Q-test, MR-Egger intercept, and leave-one-out analysis.

RESULTS

In the forward analysis, genetically predicted depressed affect and worry components of neuroticism significantly increased the risk of infertility (depressed affect: odds ratio [OR] = 1.399, 95% confidence interval [CI]: 1.054-1.856, p = 0.020; worry: OR = 1.587, 95% CI: 1.229-2.049, p = 0.000) and endometriosis (depressed affect: OR = 1.611, 95% CI: 1.234-2.102, p = 0.000; worry: OR = 1.812, 95% CI: 1.405-2.338, p = 0.000). Genetically predicted SESA component of neuroticism increased only the risk of endometriosis (OR = 1.524, 95% CI: 1.104-2.103, p = 0.010). In the reverse analysis, genetically predicted PCOS was causally associated with an increased risk of the worry component of neuroticism (Beta = 0.009, 95% CI: 0.003-0.016, p = 0.003).

CONCLUSIONS

The MR study showed that the three neuroticism personality clusters had definite causal effects on at least one specific female reproductive disease. Moreover, PCOS may increase the risk of the worry component of neuroticism. This finding suggests the need to screen for specific female reproductive diseases in populations with high neuroticism and assess the psychological status of patients with PCOS.

Assessing Fecal Microbial Diversity and Hormone Levels as Indicators of Gastrointestinal Health in Reintroduced Przewalski's Horses (Equus ferus przewalskii)

Diarrhea serves as a vital health indicator for assessing wildlife populations post-reintroduction. Upon release into the wild, wild animals undergo adaptation to diverse habitats and dietary patterns. While such changes prompt adaptive responses in the fecal microbiota, they also render these animals susceptible to gastrointestinal diseases, particularly diarrhea. This study investigates variations in fecal microorganisms and hormone levels between diarrhea-afflicted and healthy Przewalski's horses. The results demonstrate a significant reduction in the alpha diversity of the fecal bacterial community among diarrheal Przewalski's horses, accompanied by notable alterations in taxonomic composition. Firmicutes, Proteobacteria, and Bacteroidetes emerge as dominant phyla across all fecal samples, irrespective of health status. However, discernible differences in fecal bacterial abundance are observed between healthy and diarrhea-stricken individuals at the genus level, specifically, a diminished relative abundance of Pseudobutyrivibrio is observed. The majority of the bacteria that facilitate the synthesis of short-chain fatty acids, Christensenellaceae_R_7_group (Christensenellaceae), NK4A214_group (Ruminococcus), Lachnospiraceae_XPB1014_group (Lachnospiraceae), [Eubacterium]_coprostanoligenes_group (Eubacterium), Rikenellaceae_RC9_gut_group, Lachnospiraceae_AC2044_group (Lachnospiraceae), and Prevotellaceae_UcG_001 (Prevotella) are noted in diarrhea-affected Przewalski's horses, while Erysipelotrichaceae, Phoenicibacter, Candidatus_Saccharimonas (Salmonella), and Mogibacterium are present in significantly increased amounts. Moreover, levels of immunoglobulin IgA and cortisol are significantly elevated in the diarrhea group compared with the non-diarrhea group. Overall, this study underscores substantial shifts in fecal bacterial diversity, abundance, and hormone levels in Przewalski's horses during episodes of diarrhea.

Association between depressive symptoms and second primary cancer in cancer survivors: Insights from a nationally representative study

OBJECTIVE

The purpose of this study was to investigate the association between depressive symptoms and second primary cancer (SPC) in U.S. cancer survivors.

METHODS

Cancer survivors from the 2005-2018 National Health and Nutrition Examination Survey (NHANES) were included in this cross-sectional study, and depressive symptoms were defined by the Patient Health Questionnaire 9 (PHQ-9). The association between depressive symptoms and SPC was assessed via multiple logistic regression, restricted cubic spline (RCS), sensitivity, and subgroup analyses.

RESULTS

This study involved 2315 participants representing >15 million noninstitutionalized U.S. residents. Multivariate logistic regression fully adjusted for confounders revealed that cancer survivors with a PHQ-9 score ≥ 10 had a greater risk of developing SPC than those with a PHQ-9 score of 0-4 ([OR] = 1.88, 95% [CI] = 1.20-2.89, p = 0.005). The RCS showed a linear positive correlation between the PHQ-9 score and SPC (p for overall = 0.017). The robustness of this association was subsequently confirmed via multiple interpolation of missing data and different cluster-level methods (namely weighted linear regression) as sensitivity analyses. Furthermore, subgroup analyses confirmed this correlation was stronger in participants with sleep duration <7 h (p for interaction = 0.036).

CONCLUSION

Moderate to severe depressive symptoms in cancer survivors were associated with an increased risk of developing SPC, especially at <7 h of sleep.

Invalidation by medical professionals in post-treatment Lyme disease

Patients with post-treatment Lyme disease (PTLD) report negative perceptions of care and significant invalidation from medical professionals. However, the relationship of invalidation to illness severity has not been examined, nor have risk factors for invalidation been identified. This cross-sectional study enrolled 80 patients who met stringent criteria for PTLD. We examined correlations between the Illness Invalidation Inventory and measures of symptom severity, quality of life, and trust in physicians. To study the relationship between invalidation and potential demographic and clinical factors, we generated simple unadjusted and multivariate adjusted linear regression models. We found that higher 'lack of understanding' and 'discounting' subscale scores of the Illness Invalidation Inventory were significantly positively correlated with higher symptom severity, lower quality of life, and lower trust in physicians. In adjusted linear regression models, older age (lack of understanding: β = - 0.17, p = 0.008, discounting: β = - 0.19, p = 0.001, every 10 years) and male gender (lack of understanding: β = - 0.49, p = 0.016, discounting: β = - 0.51, p = 0.006) were associated with less invalidation. We also identified receiving an alternative diagnosis for PTLD as a mediator in the relationship between gender and invalidation. Based on our findings, we hypothesize that reducing invalidation within the clinical encounter could positively affect illness burden and quality of life for patients with PTLD.

Assessment of Serum Cortisol Levels in Patients with Oral Squamous Cell Carcinoma and Its Correlation with Clinical Staging, Histopathological Grading and Nodal Metastasis: A Prospective Study

Aims and Objectives

To assess the serum cortisol level in patients with oral squamous cell carcinoma and correlate this value with clinical staging of tumor using TNM staging, histopathological grading of the tumor using BRYNE'S (1992) invasive tumor front grading system and nodal metastasis using histopathology.

Materials and Methods

In this prospective study a total of 25 patients who reported with biopsy proven oral squamous cell carcinoma from Dec 2012-Nov 2014 were included. Patient's clinical parameters were recorded. Clinical staging was assessed using TNM staging. Blood sample was collected from the patient in the early morning and was sent to department of biochemistry, SDM Medical College to assess the serum cortisol levels. The obtained results of serum cortisol levels was correlated with TNM staging, histopathologic grading of the excised tumor (using BRYNE'S grading system) and nodal metastasis (which was confirmed using histopathology of neck specimen). The data was then analyzed statistically.

Results

Patients with oral SCC showed morning serum cortisol levels higher. Cortisol levels increased as the stage of the cancer advanced. There was a statistical significance between TNM and cortisol (p = 0.0001) but no significant correlation between TMS and PN status with cortisol.

Conclusion

Patients with advanced stage oral SCC showed significantly higher levels of cortisol than those in an initial stage. This study provides strong evidence that OSSS cells are influenced by neurohormonal mediators and cortisol estimation can be used a biomarker associated with the disease clinical status.

Impact of socioeconomic status on healthy immune responses in humans

Individuals with low socioeconomic status (SES) are at greater risk of contracting and developing severe disease compared with people with higher SES. Age, sex, host genetics, smoking and cytomegalovirus (CMV) serostatus are known to have a major impact on human immune responses and thus susceptibility to infection. However, the impact of SES on immune variability is not well understood or explored. Here, we used data from the Milieu Intérieur project, a study of 1000 healthy volunteers with extensive demographic and biological data, to examine the effect of SES on immune variability. We developed an Elo-rating system using socioeconomic features such as education, income and home ownership status to objectively rank SES in the 1000 donors. We observed sex-specific SES associations, such as females with a low SES having a significantly higher frequency of CMV seropositivity compared with females with high SES, and males with a low SES having a significantly higher frequency of active smoking compared with males with a high SES. Using random forest models, we identified specific immune genes which were significantly associated with SES in both baseline and immune challenge conditions. Interestingly, many of the SES associations were sex stimuli specific, highlighting the complexity of these interactions. Our study provides a new way of computing SES in human populations that can help identify novel SES associations and reinforces biological evidence for SES-dependent susceptibility to infection. This should serve as a basis for further understanding the molecular mechanisms behind SES effects on immune responses and ultimately disease.

Establishment of nomogram to predict overall survival and cancer-specific survival of local tumor resection in patients with colorectal cancer liver metastasis with unresectable metastases: a large population-based analysis

BACKGROUND AND PURPOSE

The tumour-node metastasis (TNM) classification is a common model for evaluating the prognostic value of tumour patients. However, few models have been used to predict the survival outcomes of patients with colorectal cancer liver metastasis (CRLM) with unresectable metastases who received the primary local surgery. Thus, we utilized the Surveillance, Epidemiology, and End Results (SEER) database to establish novel nomograms for predicting the overall survival (OS) and cancer-specific survival (CSS) of these patients.

METHODS

Extracted primary data on CRLM patients by local surgery from SEER database. All prognostic factors of OS and CSS were determined by Cox regression analysis. The concordance index (C-index), receiver operating characteristic (ROC) curves and calibration curves were used to further evaluate the accuracy and discrimination of these nomograms. Decision curve analysis (DCA) was executed to evaluate the nomograms for the clinical net benefit. Risk stratification analysis (RSA) was used to evaluate the reliability of them in clinical.

RESULTS

3622 eligible patients were screened and assigned to training cohort (1812) or validation cohort (1810). The age, chemotherapy, tumour grade, primary tumour site, tumour size, lymph node positive rate (LNR), marital status, and carcinoembryonic antigen (CEA) were independent prognostic factors of OS. Additionally, the age, chemotherapy, tumour grade, primary tumour site, tumour size, LNR, and CEA were independent prognostic factors of CSS. The results of C-indexes and ROC curves indicated that the established nomograms exhibited better discrimination power than TNM classification. The calibration curves demonstrated excellent agreement between the predicted and actual survival rates for 1-, 3-, and 5 year OS and CSS. Meanwhile, the validation cohort demonstrated similar results. Background the clinic context, the DCA showed that these nomograms have higher net benefits, and the RSA showed that patients were further divided into low risk, medium risk, and high risk groups according to the predicted scores from nomograms. And, the Kaplan-Meier curve and log-rank test showed that the survival differences among the three groups are statistically significant.

CONCLUSIONS

The prognostic nomograms showed very high accuracy, identifiability, and clinical practicality in predicting the OS and CSS of CRLM patients with unresectable metastases treated by local surgery at 1-, 3-, and 5 years, which might improve individualized predictions of survival risks and help clinicians formulate treatment plans.