Hannah Arem, Ruth M. Pfeiffer, Eric A. Engels, Catherine M. Alfano, and Charles E. Matthews, National Cancer Institute, Bethesda, MD; Albert Hollenbeck, AARP, Washington, DC; and Yikyung Park, Washington University School of Medicine, St Louis, MO.
J Clin Oncol. 2015 Jan 10;33(2):180-8. doi: 10.1200/JCO.2014.58.1355. Epub 2014 Dec 8.
Physical inactivity has been associated with higher mortality risk among survivors of colorectal cancer (CRC), but the independent effects of pre- versus postdiagnosis activity are unclear, and the association between watching television (TV) and mortality in survivors of CRC is previously undefined.
We analyzed the associations between prediagnosis (n = 3,797) and postdiagnosis (n = 1,759) leisure time physical activity (LTPA) and TV watching and overall and disease-specific mortality among patients with CRC. We used Cox proportional hazards regression to estimate hazard ratios (HRs) and 95% CIs, adjusting for known mortality risk factors.
Comparing survivors of CRC reporting more than 7 hours per week (h/wk) of prediagnosis LTPA with those reporting no LTPA, we found a 20% lower risk of all-cause mortality (HR, 0.80; 95% CI, 0.68 to 0.95; P for trend = .021). Postdiagnosis LTPA of ≥ 7 h/wk, compared with none, was associated with a 31% lower all-cause mortality risk (HR, 0.69; 95% CI, 0.49 to 0.98; P for trend = .006), independent of prediagnosis activity. Compared with 0 to 2 TV hours per day (h/d) before diagnosis, those reporting ≥ 5 h/d of TV before diagnosis had a 22% increased all-cause mortality risk (HR, 1.22; 95% CI, 1.06 to 1.41; P trend = .002), and more postdiagnosis TV watching was associated with a nonsignificant 25% increase in all-cause mortality risk (HR, 1.25; 95% CI, 0.93 to 1.67; P for trend = .126).
LTPA was inversely associated with all-cause mortality, whereas more TV watching was associated with increased mortality risk. For both LTPA and TV watching, postdiagnosis measures independently explained the association with mortality. Clinicians should promote both minimizing TV time and increasing physical activity for longevity among survivors of CRC, regardless of previous behaviors.
身体活动不足与结直肠癌（CRC）幸存者的死亡率升高有关，但目前尚不清楚发病前和发病后活动的独立影响，且先前尚未定义观看电视（TV）与 CRC 幸存者死亡率之间的关系。
我们分析了结直肠癌患者发病前（n=3797）和发病后（n=1759）休闲时间体力活动（LTPA）和看电视与总体和疾病特异性死亡率之间的关联。我们使用 Cox 比例风险回归来估计风险比（HR）和 95%置信区间（CI），并调整了已知的死亡风险因素。
与报告每周（w）进行超过 7 小时的 LTPA 的 CRC 幸存者相比，报告没有 LTPA 的幸存者，全因死亡率降低了 20%（HR，0.80；95%CI，0.68 至 0.95；P 趋势=0.021）。与无 LTPA 相比，每周进行≥7 小时的发病后 LTPA 与全因死亡率降低 31%相关（HR，0.69；95%CI，0.49 至 0.98；P 趋势=0.006），与发病前活动无关。与诊断前每天（d）观看 0 至 2 小时的 TV 相比，诊断前报告每天观看≥5 小时 TV 的患者全因死亡率增加 22%（HR，1.22；95%CI，1.06 至 1.41；P 趋势=0.002），而发病后更多的 TV 观看与全因死亡率增加无显著相关性 25%（HR，1.25；95%CI，0.93 至 1.67；P 趋势=0.126）。
LTPA 与全因死亡率呈负相关，而更多的 TV 观看与更高的死亡率相关。对于 LTPA 和 TV 观看，发病后的措施独立解释了与死亡率的关系。无论之前的行为如何，临床医生都应促进 CRC 幸存者减少观看电视时间和增加体力活动以延长寿命。
