Unit of Physical Activity and Cancer, Division of Environmental Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
Int J Cancer. 2013 Sep 15;133(6):1431-40. doi: 10.1002/ijc.28130. Epub 2013 Mar 18.
Evidence is emerging that physical activity (PA) may improve overall survival after breast cancer diagnosis. However, the effect of PA on breast cancer recurrence and on cause-specific mortality is less investigated. We assessed the association of pre-diagnosis PA with recurrence, overall and cause-specific survival in a prospective cohort study in Germany including 3,393 non-metastatic breast cancer patients aged 50-74 years. Cox proportional hazards models were calculated adjusted for relevant prognostic factors. During a median follow-up of 5.6 years, 367 patients deceased. Overall mortality was significantly inversely associated with pre-diagnosis recreational PA. However, this effect was mainly attributed to deaths due to causes other than breast cancer. Multiple fractional polynomial analyses yielded a nonlinear association with markedly increased non-breast cancer mortality for women who did not engage in any sports or cycling in the years before the breast cancer diagnosis with a hazard ratio (HR, none vs. any) of 1.71, 95% confidence interval (1.16, 2.52). There were no further risk reductions with increasing activity levels. The association with breast cancer-specific mortality showed a similar dose-response but was far less pronounced with HR (none vs. any) = 1.22 (0.91, 1.64). In contrast, regarding cancer recurrence the dose-response was linear. However, this association was restricted to estrogen/progesterone receptor-negative (ER-/PR-) cases (p interaction = 0.033) with HR (highest vs. no recreational PA) = 0.53 (0.24, 1.16), p trend = 0.0045. Thus, breast cancer patients with a physically inactive lifestyle pre-diagnosis may decease prematurely irrespective of their cancer prognosis. Higher levels of exercise may reduce the risk of recurrence of ER-/PR- breast tumors.
有证据表明，体力活动（PA）可能改善乳腺癌诊断后的总体生存率。然而，PA 对乳腺癌复发和特定原因死亡率的影响研究较少。我们在德国的一项前瞻性队列研究中评估了诊断前 PA 与复发、总体和特定原因生存率的关系，该研究纳入了 3393 名年龄在 50-74 岁之间的非转移性乳腺癌患者。使用 Cox 比例风险模型调整了相关预后因素。在中位随访 5.6 年期间，有 367 名患者死亡。总体死亡率与诊断前娱乐性 PA 显著负相关。然而，这种影响主要归因于乳腺癌以外原因导致的死亡。多项分数多项式分析显示，与诊断前多年不参加任何运动或骑自行车的女性相比，非乳腺癌死亡率显著增加，风险比（HR，无 vs. 有）为 1.71，95%置信区间（1.16，2.52）。随着活动水平的增加，风险进一步降低。与乳腺癌特异性死亡率的关联显示出相似的剂量反应，但程度要小得多，HR（无 vs. 有）=1.22（0.91，1.64）。相比之下，关于癌症复发，剂量反应呈线性。然而，这种关联仅限于雌激素/孕激素受体阴性（ER-/PR-）病例（p 交互=0.033），HR（最高 vs. 无娱乐性 PA）=0.53（0.24，1.16），p 趋势=0.0045。因此，诊断前生活方式不活跃的乳腺癌患者可能会因癌症预后以外的原因而过早死亡。较高的运动水平可能降低 ER-/PR-乳腺癌肿瘤复发的风险。
