J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website http://www.jocmr.org

Original Article

Volume 11, Number 3, March 2019, pages 188-195

Preoperative Depressive Mood of Patients With Esophageal Cancer Might Delay Recovery From Operation-Related Malnutrition

**Table 1.** Patients’ Preoperative Characteristics
	Normal SDS group (n = 36)	High SDS group (n = 37)	P value
Data are expressed as median (25th-75th percentile) or n (%). Mann-Whitney U test and Fisher’s exact test were performed. SDS: Self-Rating Depression Scale; BMI: body mass index.
SDS (points)	32.0 (29.0 - 35.0)	46.0 (40.0 - 51.0)	< 0.001
Sex (male/female)	31:5	23:14	0.032
Age (years)	65.0 (60.25 - 70.75)	62.0 (55.0 - 68.0)	0.047
BMI (kg/m²)	21.6 (20.5 - 23.1)	19.8 (18.0 - 21.8)	0.007
Stage
I and II	22 (61.1)	20 (54.1)	0.638
III and IV	14 (38.9)	17 (45.9)
Hospital stay (day)	27.5 (21.0 - 41.0)	28.0 (22.0 - 37.0)	0.908

Table 1. Patients’ Preoperative Characteristics

Normal SDS group (n = 36)

High SDS group (n = 37)

P value

Data are expressed as median (25th-75th percentile) or n (%). Mann-Whitney U test and Fisher’s exact test were performed. SDS: Self-Rating Depression Scale; BMI: body mass index.

SDS (points)

32.0 (29.0 - 35.0)

46.0 (40.0 - 51.0)

< 0.001

Sex (male/female)

31:5

23:14

0.032

Age (years)

65.0 (60.25 - 70.75)

62.0 (55.0 - 68.0)

0.047

BMI (kg/m²)

21.6 (20.5 - 23.1)

19.8 (18.0 - 21.8)

0.007

Stage

I and II

22 (61.1)

20 (54.1)

0.638

III and IV

14 (38.9)

17 (45.9)

Hospital stay (day)

27.5 (21.0 - 41.0)

28.0 (22.0 - 37.0)

0.908

**Table 2.** Score of Each SDS Item Before Surgery
	Normal SDS group (n = 36)	High SDS group (n = 37)	P value
Data are expressed as median (25th-75th percentile). Mann-Whitney U test was performed. SDS: Self-Rating Depression Scale.
Global rating
1. I feel down-hearted and blue	2.0 (1.0 - 2.0)	3.0 (2.0 - 4.0)	0.006
2. Morning is when I feel the best	3.0 (2.0 - 4.0)	4.0 (3.0 - 4.0)	< 0.001
3. I have crying spells or feel like it	1.0 (1.0 - 1.3)	1.0 (1.0 - 2.0)	0.003
4. I have trouble sleeping at night	1.5 (1.0 - 2.8)	2.0 (2.0 - 4.0)	0.014
5. I eat as much as I used to	1.0 (1.0 - 1.0)	3.0 (1.0 - 4.0)	0.006
6. I still enjoy sex	3.0 (2.3 - 4.0)	4.0 (3.0 - 4.0)	0.005
7. I notice that I am losing weight	1.0 (1.0 - 3.8)	4.0 (1.0 - 4.0)	0.021
8. I have trouble with constipation	1.0 (1.0 - 2.0)	2.0 (1.0 - 4.0)	0.009
9. My heart beats faster than usual	1.0 (1.0 - 1.0)	1.0 (1.0 - 1.0)	0.013
10. I get tired for no reason	1.0 (1.0 - 2.0)	2.0 (2.0 - 4.0)	< 0.001
11. My mind is as clear as it used to be	1.0 (1.0 - 3.0)	3.0 (1.0 - 4.0)	0.002
12. I find it easy to do the things I used to	1.0 (1.0 - 2.8)	3.0 (2.0 - 4.0)	< 0.001
13. I am restless and can’t keep still	1.0 (1.0 - 1.0)	1.0 (1.0 - 2.5)	0.001
14. I feel hopeful about the future	1.0 (1.0 - 2.8)	3.0 (1.0 - 4.0)	0.014
15. I am more irritable than usual	1.0 (1.0 - 1.0)	2.0 (1.0 - 3.0)	0.001
16. I find it easy to make decisions	1.0 (1.0 - 1.0)	2.0 (1.0 - 3.0)	0.014
17. I feel that I am useful and needed	1.0 (1.0 - 2.0)	3.0 (1.0 - 3.0)	0.001
18. My life is pretty full	1.0 (1.0 - 2.0)	2.0 (1.0 - 3.0)	0.001
19. I feel that others would be better off if I were dead	1.0 (1.0 - 1.0)	1.0 (1.0 - 1.0)	0.574
20. I still enjoy the things I used to do	1.0 (1.0 - 1.0)	3.0 (1.0 - 4.0)	< 0.001
Total	32.0 (29.0 - 35.0)	46.0 (40.0 - 51.0)	< 0.001

Table 2. Score of Each SDS Item Before Surgery

Normal SDS group (n = 36)

High SDS group (n = 37)

P value

Data are expressed as median (25th-75th percentile). Mann-Whitney U test was performed. SDS: Self-Rating Depression Scale.

Global rating

1. I feel down-hearted and blue

2.0 (1.0 - 2.0)

3.0 (2.0 - 4.0)

0.006

2. Morning is when I feel the best

3.0 (2.0 - 4.0)

4.0 (3.0 - 4.0)

< 0.001

3. I have crying spells or feel like it

1.0 (1.0 - 1.3)

1.0 (1.0 - 2.0)

0.003

4. I have trouble sleeping at night

1.5 (1.0 - 2.8)

2.0 (2.0 - 4.0)

0.014

5. I eat as much as I used to

1.0 (1.0 - 1.0)

3.0 (1.0 - 4.0)

0.006

6. I still enjoy sex

3.0 (2.3 - 4.0)

4.0 (3.0 - 4.0)

0.005

7. I notice that I am losing weight

1.0 (1.0 - 3.8)

4.0 (1.0 - 4.0)

0.021

8. I have trouble with constipation

1.0 (1.0 - 2.0)

2.0 (1.0 - 4.0)

0.009

9. My heart beats faster than usual

1.0 (1.0 - 1.0)

0.013

10. I get tired for no reason

1.0 (1.0 - 2.0)

2.0 (2.0 - 4.0)

< 0.001

11. My mind is as clear as it used to be

1.0 (1.0 - 3.0)

3.0 (1.0 - 4.0)

0.002

12. I find it easy to do the things I used to

1.0 (1.0 - 2.8)

3.0 (2.0 - 4.0)

< 0.001

13. I am restless and can’t keep still

1.0 (1.0 - 1.0)

1.0 (1.0 - 2.5)

0.001

14. I feel hopeful about the future

1.0 (1.0 - 2.8)

3.0 (1.0 - 4.0)

0.014

15. I am more irritable than usual

1.0 (1.0 - 1.0)

2.0 (1.0 - 3.0)

0.001

16. I find it easy to make decisions

1.0 (1.0 - 1.0)

2.0 (1.0 - 3.0)

0.014

17. I feel that I am useful and needed

1.0 (1.0 - 2.0)

3.0 (1.0 - 3.0)

0.001

18. My life is pretty full

1.0 (1.0 - 2.0)

2.0 (1.0 - 3.0)

0.001

19. I feel that others would be better off if I were dead

1.0 (1.0 - 1.0)

0.574

20. I still enjoy the things I used to do

1.0 (1.0 - 1.0)

3.0 (1.0 - 4.0)

< 0.001

Total

32.0 (29.0 - 35.0)

46.0 (40.0 - 51.0)

< 0.001

**Table 3.** Comparison of SF-8 Between the Two Groups
	Normal SDS group (n = 33)	High SDS group (n = 35)	P value
Data are expressed as median (25th-75th percentile). Mann-Whitney U test was performed. SDS: Self-Rating Depression Scale; QOL: quality of life; PCS: physical component summary; MCS: mental component summary.
%PCS (physical QOL)	101.4 (94.9 - 111.0)	95.1 (76.0 - 95.1)	0.024
%MCS (psychological QOL)	85.5 (78.4 - 97.3)	86.1 (74.8 - 95.0)	0.480

Table 3. Comparison of SF-8 Between the Two Groups

Normal SDS group (n = 33)

High SDS group (n = 35)

P value

Data are expressed as median (25th-75th percentile). Mann-Whitney U test was performed. SDS: Self-Rating Depression Scale; QOL: quality of life; PCS: physical component summary; MCS: mental component summary.

%PCS (physical QOL)

101.4 (94.9 - 111.0)

95.1 (76.0 - 95.1)

0.024

%MCS (psychological QOL)

85.5 (78.4 - 97.3)

86.1 (74.8 - 95.0)

0.480

**Table 4.** Comparison of Body Composition and Anthropometries Between the Two Groups
	Normal SDS group (n = 36)	High SDS group (n = 37)	P value
Data are expressed as median (25th-75th percentile). Mann-Whitney U test was performed. SDS: Self-Rating Depression Scale; BMI: body mass index; AC: arm circumference; TSF: triceps skinfold; AMC: arm muscle circumference; AMA: arm muscle area.
%BMI	98.6 (93.6 - 105.7)	91.4 (84.7 - 99.1)	0.015
%Body fat	123.0 (100.5 - 152.6)	100.0 (65.5 - 140.3)	0.081
%Skeletal muscle	93.6 (88.5 - 96.8)	89.4 (83.2 - 94.2)	0.036
%AC	100.4 (92.7 - 104.0)	94.4 (86.1 - 101.7)	0.022
%TSF	88.9 (77.8 - 111.1)	77.8 (65.6 - 119.6)	0.379
%AMC	101.2 (95.0 - 106.7)	98.0 (91.5 - 102.0)	0.052
%AMA	102.6 (90.0 - 113.5)	96.2 (86.9 - 104.5)	0.033
%Grip strength (n = 35:37)	83.0 (73.0 - 95.2)	73.1 (63.9 - 82.6)	0.012

Table 4. Comparison of Body Composition and Anthropometries Between the Two Groups

Normal SDS group (n = 36)

High SDS group (n = 37)

P value

Data are expressed as median (25th-75th percentile). Mann-Whitney U test was performed. SDS: Self-Rating Depression Scale; BMI: body mass index; AC: arm circumference; TSF: triceps skinfold; AMC: arm muscle circumference; AMA: arm muscle area.

%BMI

98.6 (93.6 - 105.7)

91.4 (84.7 - 99.1)

0.015

%Body fat

123.0 (100.5 - 152.6)

100.0 (65.5 - 140.3)

0.081

%Skeletal muscle

93.6 (88.5 - 96.8)

89.4 (83.2 - 94.2)

0.036

%AC

100.4 (92.7 - 104.0)

94.4 (86.1 - 101.7)

0.022

%TSF

88.9 (77.8 - 111.1)

77.8 (65.6 - 119.6)

0.379

%AMC

101.2 (95.0 - 106.7)

98.0 (91.5 - 102.0)

0.052

%AMA

102.6 (90.0 - 113.5)

96.2 (86.9 - 104.5)

0.033

%Grip strength (n = 35:37)

83.0 (73.0 - 95.2)

73.1 (63.9 - 82.6)

0.012

**Table 5.** Comparison of Preoperative Laboratory Data and Nutritional Status Assessment Between the Two Groups
	Normal SDS group (n = 36)	High SDS group (n = 37)	P value
Data are expressed as median (25th-75th percentile). Mann-Whitney U test was performed. WBC: white blood cell count; TLC: total lymphocyte count; CRP: C-reactive protein; Alb: albumin; ChE: cholinesterase; TG: triglyceride; T-Cho: total cholesterol; HDL-Cho: high-density lipoprotein cholesterol; LDL-Cho: low-density lipoprotein cholesterol; TTR: transthyretin; PNI: prognostic nutritional index; CHI: creatinine height index.
WBC (/mm³)	6,600 (5,000 - 7,200)	7,350 (5,825 - 9,100)	0.522
TLC (/mm³)	1,792 (1,407 - 2,088)	1,596 (1,199 - 1,976)	0.041
CRP (mg/dL)	0.09 (0.03 - 0.19)	0.24 (0.93 - 1.51)	0.064
Alb (g/dL)	4.1 (3.9 - 4.2)	4.0 (3.7 - 4.1)	0.018
ChE (IU/L)	299 (235 - 341)	300 (243 - 350)	0.669
		Failure: 1
TG (mg/dL)	106 (92 - 142)	136 (76 - 183)	0.736
T-Cho (mg/dL)	197 (174 - 215)	177 (151 - 208)	0.787
HDL-Cho (mg/dL)	49 (40 - 62)	41 (35 - 52)	0.128
	Failure: 10	Failure: 11
LDL-Cho (mg/dL)	112 (101 - 139)	100 (86 - 132)	0.783
	Failure: 10	Failure: 10
TTR (mg/dL)	29.1 (24.1 - 32.2)	22.6 (19.4 - 27.9)	0.009
	Failure: 7	Failure: 8
PNI (point)	50.9 (47.6 - 53.0)	46.9 (44.0 - 51.0)	0.007
CHI (%)	82.6 (48.6 - 102.0)	66.9 (56.7 - 77.9)	0.285
	Failure: 15	Failure: 13

Table 5. Comparison of Preoperative Laboratory Data and Nutritional Status Assessment Between the Two Groups

Normal SDS group (n = 36)

High SDS group (n = 37)

P value

Data are expressed as median (25th-75th percentile). Mann-Whitney U test was performed. WBC: white blood cell count; TLC: total lymphocyte count; CRP: C-reactive protein; Alb: albumin; ChE: cholinesterase; TG: triglyceride; T-Cho: total cholesterol; HDL-Cho: high-density lipoprotein cholesterol; LDL-Cho: low-density lipoprotein cholesterol; TTR: transthyretin; PNI: prognostic nutritional index; CHI: creatinine height index.

WBC (/mm³)

6,600 (5,000 - 7,200)

7,350 (5,825 - 9,100)

0.522

TLC (/mm³)

1,792 (1,407 - 2,088)

1,596 (1,199 - 1,976)

0.041

CRP (mg/dL)

0.09 (0.03 - 0.19)

0.24 (0.93 - 1.51)

0.064

Alb (g/dL)

4.1 (3.9 - 4.2)

4.0 (3.7 - 4.1)

0.018

ChE (IU/L)

299 (235 - 341)

300 (243 - 350)

0.669

Failure: 1

TG (mg/dL)

106 (92 - 142)

136 (76 - 183)

0.736

T-Cho (mg/dL)

197 (174 - 215)

177 (151 - 208)

0.787

HDL-Cho (mg/dL)

49 (40 - 62)

41 (35 - 52)

0.128

Failure: 10

Failure: 11

LDL-Cho (mg/dL)

112 (101 - 139)

100 (86 - 132)

0.783

Failure: 10

TTR (mg/dL)

29.1 (24.1 - 32.2)

22.6 (19.4 - 27.9)

0.009

Failure: 7

Failure: 8

PNI (point)

50.9 (47.6 - 53.0)

46.9 (44.0 - 51.0)

0.007

CHI (%)

82.6 (48.6 - 102.0)

66.9 (56.7 - 77.9)

0.285

Failure: 15

Failure: 13

**Table 6.** Changes in Variables at 3 and 6 Months Among Two SDS Groups
		n	Normal SDS	n	High SDS	P value
Median (25-75percentile), Mann-Whitney U test were performed; SDS, Self-rating Depression Scale; PCS, physical component summary; MCS, mental component summary.
SDS	Pre-operation	18	32.0 (29.0 - 35.0)	14	46.0 (39.0 - 50.5)	< 0.001
	3 months		36.5 (34.0 - 44.0)		49.5 (45.8 - 54.0)	0.002
	6 months		36.5 (31.0 - 41.5)		44.0 (37.8 - 51.0)	0.073
%PCS	Pre-operation	18	102.0 (93.1 - 114.0)	14	89.3 (74.1 - 103.5)	0.023
	3 months		86.6 (76.8 - 97.5)		81.8 (72.3 - 91.9)	0.303
	6 months		91.9 (78.6 - 102.6)		85.6 (80.0 - 93.4)	0.442
%MCS	Pre-operation	18	85.8 (77.6 - 99.8)	14	89.2 (78.4 - 97.4)	0.539
	3 months		85.6 (65.9 - 94.3)		86.3 (66.7 - 90.9)	0.594
	6 months		94.9 (82.5 - 102.5)		89.9 (83.6 - 100.5)	0.536
%BMI	Pre-operation	22	99.8 (93.5 - 105.7)	16	91.2 (81.6 - 106.0)	0.015
	3 months		91.1 (85.6 - 96.4)		79.3 (74.2 - 89.8)	0.03
	6 months		89.1 (84.2 - 94.2)		78.9 (74.4 - 87.8)	0.012
%Skeletal muscle	Pre-operation	22	94.8 (88.2 - 97.7)	16	88.1 (82.5 - 94.1)	0.036
	3 months		87.6 (81.3 - 92.3)		78.8 (75.3 - 85.5)	0.100
	6 months		86.9 (83.7 - 93.7)		80.5 (77.4 - 84.9)	0.013
%Body fat	Pre-operation	22	126.2 (105.1 - 147.0)	16	94.9 (71.4 - 169.6)	0.081
	3 months		102.6 (61.3 - 112.6)		61.4 (41.6 - 109.4)	0.096
	6 months		79.7 (63.0 - 106.9)		67.1 (39.2 - 96.1)	0.201
%Grip strength	Pre-operation	22	84.6 (68.3 - 103.0)	16	74.6 (65.4 - 85.7)	0.012
	3 months		67.8 (61.4 - 90.9)		62.8 (57.1 - 67.5)	0.019
	6 months		73.1 (64.2 - 90.7)		65.7 (55.1 - 76.8)	0.122

Table 6. Changes in Variables at 3 and 6 Months Among Two SDS Groups

Normal SDS

High SDS

P value

Median (25-75percentile), Mann-Whitney U test were performed; SDS, Self-rating Depression Scale; PCS, physical component summary; MCS, mental component summary.

SDS

Pre-operation

32.0 (29.0 - 35.0)

46.0 (39.0 - 50.5)

< 0.001

3 months

36.5 (34.0 - 44.0)

49.5 (45.8 - 54.0)

0.002

6 months

36.5 (31.0 - 41.5)

44.0 (37.8 - 51.0)

0.073

%PCS

Pre-operation

102.0 (93.1 - 114.0)

89.3 (74.1 - 103.5)

0.023

3 months

86.6 (76.8 - 97.5)

81.8 (72.3 - 91.9)

0.303

6 months

91.9 (78.6 - 102.6)

85.6 (80.0 - 93.4)

0.442

%MCS

Pre-operation

85.8 (77.6 - 99.8)

89.2 (78.4 - 97.4)

0.539

3 months

85.6 (65.9 - 94.3)

86.3 (66.7 - 90.9)

0.594

6 months

94.9 (82.5 - 102.5)

89.9 (83.6 - 100.5)

0.536

%BMI

Pre-operation

99.8 (93.5 - 105.7)

91.2 (81.6 - 106.0)

0.015

3 months

91.1 (85.6 - 96.4)

79.3 (74.2 - 89.8)

0.03

6 months

89.1 (84.2 - 94.2)

78.9 (74.4 - 87.8)

0.012

%Skeletal muscle

Pre-operation

94.8 (88.2 - 97.7)

88.1 (82.5 - 94.1)

0.036

3 months

87.6 (81.3 - 92.3)

78.8 (75.3 - 85.5)

0.100

6 months

86.9 (83.7 - 93.7)

80.5 (77.4 - 84.9)

0.013

%Body fat

Pre-operation

126.2 (105.1 - 147.0)

94.9 (71.4 - 169.6)

0.081

3 months

102.6 (61.3 - 112.6)

61.4 (41.6 - 109.4)

0.096

6 months

79.7 (63.0 - 106.9)

67.1 (39.2 - 96.1)

0.201

%Grip strength

Pre-operation

84.6 (68.3 - 103.0)

74.6 (65.4 - 85.7)

0.012

3 months

67.8 (61.4 - 90.9)

62.8 (57.1 - 67.5)

0.019

6 months

73.1 (64.2 - 90.7)

65.7 (55.1 - 76.8)

0.122

**Table 7.** Univariate and Multivariate ORs and 95% CIs for Association Recovery of %BMI as 85% or More at 3 Months after Surgery
		%BMI ≥ 85 (n = 32)	%BMI < 85 (n = 19)	Univariate OR (95% CI)	P value	Multivariate OR (95% CI)^a	P value
^aModel included SDS and PNI. chemo: chemotherapy; SDS: Self-Rating Depression Scale; PNI: prognostic nutritional index.
Sex	Female	7	8	1
	Male	25	11	2.60 (0.75 - 8.95)	0.131
Age (years)	< 65	19	11	1
	≥ 65	13	8	1.06 (0.34 - 3.36)	0.917
Stage	I and II	20	8	1
	III and IV	12	11	2.29 (0.72 - 7.30)	0.161
Chemotherapy	Absence	14	9	1
	Prescription	18	10	0.86 (0.28 - 2.70)	0.802
SDS (point)	< 39	23	7	1		1
	≥ 39	9	12	4.38 (1.31 - 14.68)	0.017	4.07 (1.15 - 14.35)	0.029
PNI (point)	≥ 49	22	7	1		1
	< 49	10	12	3.77 (1.14 - 12.46)	0.029	3.47 (0.98 - 12.24)	0.053

Table 7. Univariate and Multivariate ORs and 95% CIs for Association Recovery of %BMI as 85% or More at 3 Months after Surgery

%BMI ≥ 85 (n = 32)

%BMI < 85 (n = 19)

Univariate OR (95% CI)

P value

Multivariate OR (95% CI)^a

P value

^aModel included SDS and PNI. chemo: chemotherapy; SDS: Self-Rating Depression Scale; PNI: prognostic nutritional index.

Sex

Female

Male

2.60 (0.75 - 8.95)

0.131

Age (years)

< 65

≥ 65

1.06 (0.34 - 3.36)

0.917

Stage

I and II

III and IV

2.29 (0.72 - 7.30)

0.161

Chemotherapy

Absence

Prescription

0.86 (0.28 - 2.70)

0.802

SDS (point)

< 39

≥ 39

4.38 (1.31 - 14.68)

0.017

4.07 (1.15 - 14.35)

0.029

PNI (point)

≥ 49

< 49

3.77 (1.14 - 12.46)

0.029

3.47 (0.98 - 12.24)

0.053