1Faculty of Physical Education, University of Alberta, Edmonton, Alberta, CANADA; 2Ottawa Hospital Regional Cancer Center, Ottawa, Ontario, CANADA; 3School of Kinesiology, University of British Columbia, Vancouver, British Columbia, CANADA; 4British Columbia Cancer Agency, Vancouver, British Columbia, CANADA; 5Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, Alberta, CANADA; 6University of Ottawa Heart Institute, Ottawa, Ontario, CANADA; and 7Cross Cancer Institute, Edmonton, Alberta, CANADA.
Med Sci Sports Exerc. 2014 Sep;46(9):1744-51. doi: 10.1249/MSS.0000000000000297.
Observational studies suggest that physical activity after a breast cancer diagnosis is associated with improved cancer outcomes; however, no randomized data are available. Here, we report an exploratory follow-up of cancer outcomes from the Supervised Trial of Aerobic versus Resistance Training (START).
The START was a Canadian multicenter trial that randomized 242 breast cancer patients between 2003 and 2005 to usual care (n = 82), supervised aerobic (n = 78), or resistance (n = 82) exercise during chemotherapy. The primary end point for this exploratory analysis was disease-free survival (DFS). Secondary end points were overall survival, distant DFS, and recurrence-free interval. The two exercise arms were combined for analysis (n = 160), and selected subgroups were explored.
After a median follow-up of 89 months, there were 25/160 (15.6%) DFS events in the exercise groups and 18/82 (22.0%) in the control group. Eight-year DFS was 82.7% for the exercise groups compared with 75.6% for the control group (HR, 0.68; 95% confidence interval (CI), 0.37-1.24; log-rank, P = 0.21). Slightly stronger effects were observed for overall survival (HR, 0.60; 95% CI, 0.27-1.33; log-rank, P = 0.21), distant DFS (HR, 0.62; 95% CI, 0.32-1.19; log-rank, P = 0.15), and recurrence-free interval (HR, 0.58; 95% CI, 0.30-1.11; Gray test, P = 0.095). Subgroup analyses suggested potentially stronger exercise effects on DFS for women who were overweight/obese (HR, 0.59; 95% CI, 0.27-1.27), had stage II/III cancer (HR, 0.61; 95% CI, 0.31-1.20), estrogen receptor-positive tumors (HR, 0.58; 95% CI, 0.26-1.29), human epidermal growth factor receptor 2-positive tumors (HR, 0.21; 95% CI, 0.04-1.02), received taxane-based chemotherapies (HR, 0.46; 95% CI, 0.19-1.15), and ≥85% of their planned chemotherapy (HR, 0.50; 95% CI, 0.25-1.01).
This exploratory follow-up of the START provides the first randomized data to suggest that adding exercise to standard chemotherapy may improve breast cancer outcomes. A definitive phase III trial is warranted.
目的：观察性研究表明，乳腺癌诊断后进行身体活动与改善癌症结局相关；然而，目前尚无随机数据。本研究报告了对加拿大多中心的有氧与抗阻训练对照试验（START）癌症结局的探索性随访结果。
方法：START 是一项在 2003 年至 2005 年期间对 242 名乳腺癌患者进行的随机对照试验，将患者分为常规护理组（n=82）、监督有氧组（n=78）或监督抗阻组（n=82）。此探索性分析的主要终点是无病生存（DFS）。次要终点包括总生存、远处 DFS 和无复发生存期。将两个运动组合并进行分析（n=160），并对选定的亚组进行了探索。
结果：中位随访 89 个月后，运动组有 25/160（15.6%）例DFS 事件，对照组有 18/82（22.0%）例。运动组的 8 年 DFS 为 82.7%，对照组为 75.6%（HR，0.68；95%CI，0.37-1.24；对数秩检验，P=0.21）。总生存（HR，0.60；95%CI，0.27-1.33；对数秩检验，P=0.21）、远处 DFS（HR，0.62；95%CI，0.32-1.19；对数秩检验，P=0.15）和无复发生存期（HR，0.58；95%CI，0.30-1.11；格雷检验，P=0.095）的观察效果稍强。亚组分析表明，超重/肥胖（HR，0.59；95%CI，0.27-1.27）、Ⅱ/Ⅲ期癌症（HR，0.61；95%CI，0.31-1.20）、雌激素受体阳性肿瘤（HR，0.58；95%CI，0.26-1.29）、人表皮生长因子受体 2 阳性肿瘤（HR，0.21；95%CI，0.04-1.02）、接受紫杉烷类化疗（HR，0.46；95%CI，0.19-1.15）和接受≥85%计划化疗（HR，0.50；95%CI，0.25-1.01）的女性患者，运动对 DFS 的潜在影响可能更强。
结论：START 的这项探索性随访提供了第一个随机数据，表明在标准化疗的基础上增加运动可能改善乳腺癌结局。需要进行一项明确的 III 期试验。
