Association of depressive symptoms with quality of life and treatment efficacy in patients with intermediate or advanced hepatocellular carcinoma receiving immunotherapy: A prospective cohort study

Background Depression is prevalent among individuals with cancer. This prospective cohort study aims to examine the relationships between depressive symptoms and both quality of life (QoL) and treatment efficacy in patients with intermediate or advanced hepatocellular carcinoma (HCC) who are receiving immunotherapy. Methods A cohort of 156 patients with intermediate or advanced HCC who were receiving immunotherapy was included in the analysis. Depressive symptoms were evaluated utilizing the Patient Health Questionnaire-9 (PHQ-9). The primary outcome was progression-free survival (PFS), whereas the secondary outcomes were the objective response rate (ORR), disease control rate (DCR), overall survival (OS), and QoL. Results Nearly half (48.7%) of the patients exhibited depressive symptoms. Over a median follow-up period of 10 months, patients with depressive symptoms had significantly lower PFS (HR 4.31, 95% CI: 2.75–6.76) and significantly shorter OS (HR 5.39, 95% CI: 1.84–15.82). Furthermore, the ORR and DCR were notably lower in patients with depressive symptoms (ORR 10.5% compared with 37.5%; DCR 52.6% compared with 91.2%). QoL scores were significantly lower at all assessed time points for patients with depressive symptoms, indicating worse overall well-being. Conclusions Depression is significantly associated with the efficacy of immunotherapy in HCC patients and is negatively associated with both clinical outcomes and QoL. Addressing mental health is essential for optimizing treatment strategies and improving overall patient outcomes in this population.