慢性应激与癌症患者死亡率升高之间的机制尚不完全清楚。本研究旨在检验以下假设：在活动性头颈癌患者中，癌症分期时与较高的应激相关神经活动（即代谢性杏仁核活动[AA]）相关联。研究为回顾性队列研究。研究地点为学术医疗中心（马萨诸塞州总医院，波士顿）。纳入了240例进行18F-FDG-PET/CT成像作为初始癌症分期的头颈癌患者。通过将圆形感兴趣区域放置在右侧和左侧杏仁核并测量每个感兴趣区域的平均示踪剂积累（即标准摄取值[SUV]）来确定杏仁核中的18F-FDG摄取。背景脑活动（颞叶SUV均值）修正了杏仁核摄取。在头颈癌患者中（年龄59±13岁；30%女性），在中位随访期为3年（IQR：1.7-5.1），有67人死亡。AA与骨髓活性增高、白细胞增多和C-反应蛋白相关（每个P<0.05）。在调整后和未调整分析中，AA与随后的死亡相关（HR [95% CI]：1.35 [1.07-1.70]，P = 0.009）；该关联在仅纳入晚期癌症阶段患者的分层子集分析中仍然存在（每个P<0.001）。AA最高三分位数的个体与其它个体相比，死亡率提高了两倍（P = 0.01）。较高AA的患者的无进展生存中位时间为25个月，而其他个体为36.5个月，进展或死亡的HR [95%CI]为1.83 [1.24-2.68]，P = 0.001）。18F-FDG-PET/CT成像所得到的AA独立且可靠地预测了头颈癌患者的死亡率和癌症进展。未来的研究应该测试减轻AA（或其下游生物学后果）的策略是否能提高癌症的生存率。版权所有: © 2023年Hassan等人。本文是根据知识共享许可协议开放获取的文章，该协议允许在任何媒介中自由使用、分发和重制原作者和来源的文章，只要提供原始作者和来源。

The mechanisms underlying the association between chronic stress and higher mortality among individuals with cancer remain incompletely understood.To test the hypotheses that among individuals with active head and neck cancer, that higher stress-associated neural activity (ie. metabolic amygdalar activity [AmygA]) at cancer staging associates with survival.Retrospective cohort study.Academic Medical Center (Massachusetts General Hospital, Boston).240 patients with head and neck cancer (HNCA) who underwent 18F-FDG-PET/CT imaging as part of initial cancer staging.18F-FDG uptake in the amygdala was determined by placing circular regions of interest in the right and left amygdalae and measuring the mean tracer accumulation (i.e., standardized uptake value [SUV]) in each region of interest. Amygdalar uptake was corrected for background cerebral activity (mean temporal lobe SUV).Among individuals with HNCA (age 59±13 years; 30% female), 67 died over a median follow-up period of 3 years (IQR: 1.7-5.1). AmygA associated with heightened bone marrow activity, leukocytosis, and C-reactive protein (P<0.05 each). In adjusted and unadjusted analyses, AmygA associated with subsequent mortality (HR [95% CI]: 1.35, [1.07-1.70], P = 0.009); the association persisted in stratified subset analyses restricted to patients with advanced cancer stage (P<0.001). Individuals within the highest tertile of AmygA experienced a 2-fold higher mortality rate compared to others (P = 0.01). The median progression-free survival was 25 months in patients with higher AmygA (upper tertile) as compared with 36.5 months in other individuals (HR for progression or death [95%CI], 1.83 [1.24-2.68], P = 0.001).AmygA, quantified on routine 18F-FDG-PET/CT images obtained at cancer staging, independently and robustly predicts mortality and cancer progression among patients with HNCA. Future studies should test whether strategies that attenuate AmygA (or its downstream biological consequences) may improve cancer survival.Copyright: © 2023 Hassan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.