本帖最後由 lsc0019 於 2009-7-21 23:47 編輯
作者：Roxanne Nelson
出處：WebMD醫學新聞
July 7, 2009 — 對部分癌症病患而言，疾病的第一個病徵為精神症狀。根據發表於7月15日國際癌症期刊的研究結果，特別是在腦瘤與小細胞肺癌（SCLC）。
丹麥研究者們發現，在第一次接受精神症狀評估後的一個月內，被診斷為任何型式癌症的勝算為2.61倍。但是對腦瘤而言，這個發生率比值增加將近19倍。
主要作者、來自丹麥Aarhus大學與丹麥癌症學會的Michael E. Benros醫師表示，我們的研究結果描繪了對第一次有精神症狀病患進行完整理學檢查的重要性。整體癌症發生率以年齡超過50歲以上第一次因為情緒異常住院患者最高，每54位病患中就有1位在診斷第一年內發生惡性腫瘤。
他向Medscape腫瘤學表示，風險最高的集中在50至64歲之間。整體癌症發生率增加將近4倍，而腦部腫瘤增加37倍。
Benros醫師表示，副癌症候群過去曾經在最終發現罹患小細胞肺癌患者身上發現。但是我們的研究第一次發現精神症狀也是如此，他指出，小細胞肺癌的發生率次於腦瘤。
Benros醫師表示，副癌症候群神經異常被假設最常發生在SCLC病患身上，而非SCLC病患的頻率較低，因為罹患SCLC病患會產生與腫瘤抗原與神經系統作用的抗體，接著可能引發副癌症候神經異常與精神症狀。
他附帶表示，副癌精神異常也部分解釋了肺癌，特別是SCLC，轉移到腦部的機率最高。這些轉移接著會因為壓力直接引發精神症狀。SCLC也可以刺激異位性荷爾蒙分泌，可能接著引發精神症狀，但是我們的研究無法提供任何有關於因果關係的證據。
【腦瘤與肺癌的高發生率】
在他們的研究中，Benros醫師與其同事們研究可能是因為未偵測到的癌症或是部分副癌症候群造成精神症狀的可能性。以來自丹麥精神中心註冊資料庫，研究者們評估自1994年到2003年10年間4,320,623位發生精神症狀與癌症的個體資料。在這段時間，202,144位個體第一次發生精神症狀，而208,995位被診斷罹患癌症。
從1994年到2003年，總共有4,132位有第一次因精神症住住院或是門診的紀錄，且接著被診斷罹癌。在這群病患中，1,267位在第一次精神問題就診的第一年內被診斷罹癌，且這群患者中，145位罹患原發性腦瘤。
該團隊評估在第一次精神問題就診的起始三個月內，癌症整體發生率比值是上升的。在第一個月時，整體癌症發生率比值為2.61（95% CI為2.31-2.95）、腦瘤為18.85（95% CI為14.52-24.48）、肺癌為2.98（95% CI為2.16-4.12）。SCLC特定發生率比值為6.13（95% CI為3.39-11.07）。
一般而言，增加的發生率比值在前三個月下降到統計上不顯著的程度。除了腦瘤以外，在第一次因精神症狀就醫後的九個月內，發生率比值仍然顯著地上升。
Benros醫師表示，未來的研究應該針對第一次有症狀的精神疾病病患次組進行可能的篩檢。50歲以後發生的精神異常應該是進行腦部造影的一個適應症，且如果他們是吸菸者的話，病患應該接受抗體檢查，例如anti-Hu抗體，但是更正式檢查的經濟效益則超出了我們研究的範圍。
Benros醫師接受Fabrikant Einar Willumsens Mindelegat的個人贊助。
Psychiatric Symptoms May Be First Sign of Undetected Cancer
By Roxanne Nelson
Medscape Medical News
July 7, 2009 — For some cancer patients, the first manifestation of the disease is a psychiatric symptom. This was found to be particularly true for brain tumors and small-cell lung cancer (SCLC), according to a study in the June 15 issue of the International Journal of Cancer.
Within the first month following a first-time evaluation for a psychiatric symptom, Danish researchers found that the odds of being diagnosed with any type of malignancy were increased 2.61-fold. But for brain tumors, the incidence rate ratio was increased almost 19-fold.
"Our study illustrates the importance of making a thorough physical examination of patients with first-time psychiatric symptoms," said lead author Michael E. Benros, MD, from the University of Aarhus, in Denmark, and the Danish Cancer Society. "The overall cancer incidence was highest in persons older than 50 years of age admitted with a first-time mood disorder, where 1 out of 54 patients would have a malignant cancer diagnosed within the first year."
The highest risk was concentrated in the range of 50 to 64 years of age, he told Medscape Oncology. "The overall incidence of cancer was increased almost 4-fold and the incidence of brain tumors was increased 37 times."
Dr. Benros also noted that paraneoplastic neurological disorders have previously been reported in patients who subsequently were found to have small-cell lung cancer. "But our study is the first to indicate that this is also the case with psychiatric symptoms, where patients with SCLC had the highest incidence after patients with brain tumors," he said.
It is hypothesized that paraneoplastic neurological disorders are most often induced in patients with SCLC, as well as in non-SCLC but with less frequency, because patients with SCLC produce antibodies that react with both the tumor antigens and the nervous system, explained Dr. Benros. This is turn might induce both the paraneoplastic neurological disorders and the psychiatric symptoms.
"The etiology of paraneoplastic psychiatric disorders is also partly explained by the fact that lung cancer, especially SCLC, tends to have the highest risk of metastasis to the brain," he added. "These metastases could then induce psychiatric symptoms by direct pressure. SCLC can also stimulate ectopic hormone production, which might then induce psychiatric symptoms, but our study cannot provide any evidence regarding causal mechanisms."
High Incidence of Brain Tumors and Lung Cancer
In their study, Dr. Benros and colleagues investigated the possibility that psychiatric symptoms could be caused by an undetected malignancy or be part of a paraneoplastic syndrome. Using data from the Danish Psychiatric Central Register and the Danish Cancer Registry, the researchers evaluated the occurrence of psychiatric symptoms and cancer in 4,320,623 million individuals who were followed in the 10-year period from 1994 to 2003. During this time, 202,144 persons had a first-time psychiatric contact and 208,995 were diagnosed with cancer.
From 1994 to 2003, a total of 4132 persons had a first-time psychiatric in- or outpatient contact and were subsequently diagnosed with cancer. Of this group, 1267 patients were diagnosed with cancer within the first year following their first-time psychiatric contact, and within this cohort, 145 persons had primary brain tumors.
The team observed that there was an increased overall incidence rate ratio of cancer during the initial 3-month period following a first-time psychiatric contact. During the first month, the incidence rate ratio of overall cancer was 2.61 (95% CI, 2.31 – 2.95), for brain tumors 18.85 (95% CI, 14.52 – 24.48), and for lung cancer 2.98 (95% CI, 2.16 – 4.12). The specific incidence rate ratio for SCLC was 6.13 (95% CI, 3.39 – 11.07).
In general, the increased incidence rates for most cancers decreased to a nonsignificant level within the first 3 months. The exception was for brain tumors, for which the incidence rate ratio remained significantly elevated during the first 9 months following a first-time psychiatric contact.
"Future studies should address a possible screening of subgroups of psychiatric patients with first-time symptoms," said Dr. Benros. "Psychiatric disorders with onset after the age of 50 could be an indication for brain imaging and, if they are smokers, patients could be examined for antibodies such as anti-Hu, but a more formal analysis of costs and benefits was beyond the scope of our study."
Dr. Benros received a personal grant from Fabrikant Einar Willumsens Mindelegat.
Int J Cancer. 2009;124:2917–2922. |
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