Association of inflammation and depression in renal cell carcinoma.

Abstract

658 Background: Patients with cancer experience depression at higher rates, which is associated with worse outcomes and quality of life. In renal cell carcinoma (RCC) specifically, depression is particularly prevalent. Aside from the emotional distress of a cancer diagnosis, a biologic basis for cancer associated depression is inflammation, which is highly associated with RCC as well as worse outcomes. Here, we aim to assess the association between inflammation and major depression, measured by a score of 10+ on the Patient Health Questionnaire (PHQ-8), in patients undergoing nephrectomy for nonmetastatic RCC. Methods: A retrospective review of prospectively administered PHQ-8 surveys in patients that underwent nephrectomy for nonmetastatic RCC was conducted. Patients with available preoperative PHQ-8 within 180 days before surgery were included. Association of major depression on PHQ-8 with patient/tumor characteristics were determined by Generalized chi-square test or Fisher’s exact test for categorical variables and Wilcoxon rank-sum test for continuous variables. Multivariable logistic regression was used to determine variables significantly associated with major depression on PHQ-8, including pre-operative C-Reactive Protein (CRP) independently and combined with American Joint Committee on Cancer (AJCC) staging for RCC. Results: 224 patients were analyzed, with 67% being male. Median age and BMI was 64 and 29.0, respectively. 65.2% of patients were white, and 28.6% were black. Histologically, most patients had clear cell RCC (67.4%). AJCC staging was 52.2% stage I, 5.36% stage II, and 42.41% stage III. 30.4% had an elevated CRP (>10mg/L). Median PHQ-8 score was 4, with 42 (18.8%) of patients screening positive for major depression on PHQ-8 (10+). Multivariable regression models showed elevated CRP alone (OR 2.74, 95% CI 1.02-7.40, p=0.047) and in-combination with AJCC stage I-II (OR=8.13, 95% CI 1.99-33.27, p=0.004) and III (OR=4.82, CI 1.11-20.88, p=0.035) as a predictor of major depression on PHQ-8. Conclusions: In this study of patients with nonmetastatic RCC, elevated CRP (>10mg/L) was an independent predictor of major depression on PHQ-8. [Table: see text]