Determinants of psychological emotions in lung cancer patients and their correlations with tumor markers and inflammatory cytokines

Table 1 Comparison of patients’ anxiety and depression scores, mean ± SD

	Total score (n = 128)	Grouping	Score	t	P value
SAS score	48.84 ± 7.56	Anxiety (n = 56)	56.68 ± 4.17	15.02	< 0.0001
		Non-anxiety (n = 72)	43.51 ± 4.82
SDS score	50.20 ± 8.81	Depression (n = 51)	58.53 ± 4.09	13.66	< 0.0001
		Non-depression (n = 77)	44.69 ± 6.42

SAS: Self-Rating Anxiety Scale; SDS: Self-Rating Depression Scale.

Table 2 Univariate analysis of clinical characteristics of patients with or without anxiety, mean ± SD

	Anxiety (n = 56)	Non-anxiety (n = 72)	χ2/t	P value
Sex			0.723	0.395
Male	33	37
Female	23	35
Age	64.64 ± 3.02	62.31 ± 2.94	4.408	< 0.0001
Body mass index	22.78 ± 2.27	23.51 ± 2.91	1.562	0.121
Educational level			9.297	0.010
Junior high school or below	23	13
College, vocational school, or high school	20	29
University degree or above	13	30
Marital status			2.096	0.351
Single	25	39
Married	14	11
Divorced or widowed	17	22
Residence			4.053	0.044
Urban	25	45
Rural	31	27
Per capita monthly household income (yuan)			10.342	0.006
< 4000	27	17
4000-6000	20	29
> 6000	9	26
Healthcare payment method			0.008	0.928
Medical insurance	33	43
Self-pay	23	29
Living arrangement			0.113	0.737
Solitary living	24	33
Shared living	32	39
Histopathological type			0.310	0.857
Adenocarcinoma	30	38
Squamous cell carcinoma	20	24
Other	6	10
Tumor staging			5.923	0.015
III	27	50
IV	29	22
Toxic and side effects			5.450	0.020
Grade 0-2	25	47
Grade 3-4	31	25

Table 3 Determinants of anxiety in lung cancer patients

Variable	β	SE	Wald	P value	HR	95%CI
Constant	-20.867	5.413	14.862	0.000	0.000
Age (continuous variable)	0.305	0.082	13.692	0.000	1.356	1.154-1.594
Education level
0 = junior high school or below			4.845	0.089
1 = university, technical secondary school, or high school	-0.480	0.541	0.786	0.375	0.619	0.214-1.787
2 = university or above	-1.231	0.564	4.757	0.029	0.292	0.097-0.883
Per capita monthly household income (yuan)
0 ≥ 6000			11.174	0.004
1 = 4000-6000	0.913	0.578	2.490	0.115	2.491	0.802-7.737
2 ≤ 4000	1.973	0.600	10.807	0.001	7.195	2.218-23.333
Residence (0 = urban, 1 = rural)	0.577	0.450	1.646	0.200	1.781	0.737-4.302
Tumor staging (0 = III, 1 = IV)	0.586	0.459	1.628	0.202	1.797	0.730-4.423
Toxic and side effect (0 = grades 0-2, 1 = grades 3-4)	0.625	0.445	1.975	0.160	1.869	0.781-4.471

HR: Hazard ratio; CI: Confidence interval.

Table 4 Univariate analysis of clinical characteristics of patients with depression or not, mean ± SD

	Depression (n = 51)	Non-depression (n = 77)	χ2/t	P value
Sex			0.470	0.493
Male	26	44
Female	25	33
Age	62.75 ± 3.27	63.71 ± 3.09	1.698	0.092
Body mass index	23.46 ± 2.80	23.01 ± 2.57	0.928	0.350
Educational level			1.205	0.548
Junior high school or below	13	23
College, vocational school, or high school	18	31
University degree or above	20	23
Marital status			7.337	0.026
Single	18	46
Married	13	12
Divorced or widowed	20	19
Residence			2.221	0.136
Urban	32	38
Rural	19	39
Per capita monthly household income (yuan)			9.737	0.008
< 4000	24	20
4000-6000	20	29
> 6000	7	28
Healthcare payment method			0.399	0.528
Medical insurance	32	44
Self-pay	19	33
Living arrangement			16.821	< 0.0001
Solitary living	34	23
Shared living	17	54
Histopathological type			3.599	0.165
Adenocarcinoma	28	40
Squamous cell carcinoma	20	24
Other	3	13
Tumor staging			0.237	0.626
III	32	45
IV	19	32
Toxic and side effect			2.929	0.087
Grade 0-2	33	38
Grade 3-4	18	39

Table 5 Analysis of depression-associated determinants in lung cancer patients

Variable	β	SE	Wald	P value	HR	95%CI
Constant	-2.556	0.569	20.163	0.000	0.078
Marital status
0 = single			5.849	0.054
1 = married	0.811	0.547	2.200	0.138	2.251	0.771-6.577
2 = divorced or widowed	1.099	0.474	5.371	0.020	3.001	1.185-7.599
Per capita monthly household income (yuan)			7.810	0.020
0 ≥ 6000
1 = 4000-6000	0.966	0.555	3.033	0.082	2.627	0.886-7.793
2 ≤ 4000	1.598	0.572	7.789	0.005	4.941	1.609-15.174
Living arrangement (0 = shared living, 1 = solitary living)	1.372	0.412	11.087	0.001	3.945	1.759-8.848

HR: Hazard ratio; CI: Confidence interval.

Table 6 Comparison of tumor marker levels, mean ± SD

	CEA (ng/mL)	SCC-Ag (ng/mL)	NSE (ng/mL)	proGRP (pg/mL)	CYFRA21-1 (ng/mL)
Anxiety (n = 56)	59.97 ± 8.65	1.34 ± 0.34	27.00 ± 3.00	35.83 ± 5.70	10.43 ± 1.92
Non-anxiety (n = 72)	53.58 ± 6.83	1.29 ± 0.32	22.22 ± 3.04	34.43 ± 5.29	9.33 ± 2.26
t	4.678	0.897	8.869	1.433	2.914
P value	< 0.0001	0.371	< 0.0001	0.154	0.004
Depression (n = 51)	58.96 ± 9.11	1.26 ± 0.30	25.19 ± 3.92	34.36 ± 5.25	10.80 ± 2.11
Non-depression (n = 77)	54.66 ± 7.25	1.35 ± 0.34	23.73 ± 3.70	35.49 ± 5.64	9.15 ± 1.98
t	2.960	1.444	2.132	1.144	4.484
P value	0.004	0.151	0.035	0.255	< 0.0001

CEA: Carcinoembryonic antigen; SCC-Ag: Squamous cell carcinoma antigen; NSE: Neuron-specific enolase; proGRP: Pro-gastrin-releasing peptide; CYFRA21-1: Cytokeratin fragment antigen 21-1.

Table 7 Levels of inflammatory cytokines, mean ± SD

	CRP (mg/L)	IL-6 (ng/L)	TNF-α (ng/L)
Anxiety (n = 56)	5.95 ± 2.34	14.06 ± 3.86	14.28 ± 4.21
Non-anxiety (n = 72)	5.81 ± 2.13	10.59 ± 3.11	9.80 ± 3.38
t	0.344	5.629	6.690
P value	0.732	< 0.0001	< 0.0001
Depression (n = 51)	5.86 ± 1.97	13.13 ± 3.39	13.07 ± 3.63
Non-depression (n = 77)	5.88 ± 2.38	11.43 ± 4.01	10.89 ± 4.61
t	0.036	2.491	2.849
P value	0.971	0.014	0.005

CRP: C-reactive protein; IL: Interleukin; TNF: Tumor necrosis factor.

Table 8 Correlation of Self-Rating Anxiety Scale and Self-Rating Depression Scale scores with marker levels

	CEA (ng/mL)		NSE (ng/mL)		CYFRA21-1 (ng/mL)		IL-6 (ng/L)		TNF-α (ng/L)
	r	P value	r	P value	r	P value	r	P value	r	P value
SAS	0.327	0.0002	0.486	< 0.0001	0.198	0.025	0.350	< 0.0001	0.436	< 0.0001
SDS	0.240	0.006	0.255	0.004	0.293	0.001	0.277	0.002	0.266	0.002

SAS: Self-Rating Anxiety Scale; SDS: Self-Rating Depression Scale; CEA: Carcinoembryonic antigen; NSE: Neuron-specific enolase; CYFRA21-1: Cytokeratin fragment antigen 21-1; IL: Interleukin; TNF: Tumor necrosis factor.