Effects of Depression and Anxiety on Survival Prognosis Among Individuals With Gastric and/or Esophageal Cancer: Systematic Review and Meta‐Analysis

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ABSTRACT Background Depression and anxiety are prevalent among patients with esophagogastric cancers and may adversely affect survival, yet their prognostic significance in this population remains unclear. We conducted the first systematic review and meta‐analysis to quantify the impact of baseline depressive and anxiety symptoms on survival outcomes in patients with esophageal and gastric cancers. Methods Following PRISMA guidelines, we searched PubMed, Scopus, Embase, and Web of Science through July 2, 2025. Eligible studies reported hazard ratios (HRs) for overall survival (OS), disease‐free survival (DFS), or progression‐free survival (PFS) in adults with histologically confirmed esophagogastric cancer and assessed depression and/or anxiety using validated instruments. Two reviewers independently screened records, extracted data, and appraised study quality. We pooled multivariate‐adjusted HRs using random‐effects models, assessed heterogeneity with I 2 , and examined publication bias via Egger's and Begg's tests. Sensitivity analyses used a leave‐one‐out approach. Results Ten studies ( n = 10,442) met the inclusion criteria, of which six provided sufficient data for meta‐analysis. When depression and/or anxiety were analyzed collectively among patients with gastric or esophageal cancer, the pooled hazard ratio (HR) indicated a significant association with poorer survival (HR = 1.64; 95% CI: 1.31–2.06; p < 0.05; I 2 = 51.22%). Depression alone was also significantly associated with worse overall survival (HR = 1.77; 95% CI: 1.29–2.44; p < 0.05; I 2 = 60.05%). A subgroup analysis limited to gastric cancer patients revealed a similarly significant association for combined depression and anxiety (HR = 1.68; 95% CI: 1.28–2.21; p < 0.05; I 2 = 39.43%). Sensitivity analyses demonstrated that no single study significantly altered the results. Evidence of potential publication bias was observed in Egger's test for both the full sample and depression‐only models ( p = 0.001). For Begg's test, a significant result was found in the full sample ( p = 0.024), whereas no significant bias was detected in the depression‐only model ( p = 0.221). No publication bias was detected in the gastric cancer subgroup (Egger's p = 0.08; Begg's p = 0.29). Discussion Depression and anxiety appear to predict poorer survival in esophagogastric cancer patients, underscoring the prognostic importance of psychological distress. Future prospective studies with standardized, longitudinal assessments of mental health and interventional trials are needed to clarify causal pathways and test whether psychological support can improve survival and quality of life in this vulnerable population.

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