Van Blarigan Erin L, Meyerhardt Jeffrey A
Erin L. Van Blarigan, University of California San Francisco, San Francisco, CA; and Jeffrey A. Meyerhardt, Dana-Farber Cancer Institute, Boston, MA.
J Clin Oncol. 2015 Jun 1;33(16):1825-34. doi: 10.1200/JCO.2014.59.7799. Epub 2015 Apr 27.
This review summarizes the evidence regarding physical activity and diet after colorectal cancer diagnosis in relation to quality of life, disease recurrence, and survival. There have been extensive reports on adiposity, inactivity, and certain diets, particularly those high in red and processed meats, and increased risk of colorectal cancer. Only in the past decade have data emerged on how such lifestyle factors are associated with outcomes in colorectal cancer survivors. Prospective observational studies have consistently reported that physical activity after colorectal cancer diagnosis reduces mortality. A meta-analysis estimated that each 15 metabolic equivalent task-hour per week increase in physical activity after colorectal cancer diagnosis was associated with a 38% lower risk of mortality. No randomized controlled trials have been completed to confirm that physical activity lowers risk of mortality among colorectal cancer survivors; however, trials have shown that physical activity, including structured exercise, is safe for colorectal cancer survivors (localized to metastatic stage, during and after treatment) and improves cardiorespiratory fitness and physical function. In addition, prospective observational studies have suggested that a Western dietary pattern, high carbohydrate intake, and consuming sugar-sweetened beverages after diagnosis may increase risk of colorectal cancer recurrence and mortality, but these data are limited to single analyses from one of two US cohorts. Additional data from prospective studies and randomized controlled trials are needed. Nonetheless, on the basis of the available evidence, it is reasonable to counsel colorectal cancer survivors to engage in regular physical activity and limit consumption of refined carbohydrates, red and processed meats, and sugar-sweetened beverages.
本综述总结了有关结直肠癌诊断后身体活动和饮食与生活质量、疾病复发及生存关系的证据。关于肥胖、缺乏运动以及某些饮食，尤其是红肉和加工肉类含量高的饮食与结直肠癌风险增加的报道颇多。直到过去十年，才有数据表明这些生活方式因素与结直肠癌幸存者的预后如何相关。前瞻性观察性研究一致报告称，结直肠癌诊断后的身体活动可降低死亡率。一项荟萃分析估计，结直肠癌诊断后每周身体活动量每增加15代谢当量任务小时，死亡风险降低38%。尚无随机对照试验完成以证实身体活动能降低结直肠癌幸存者的死亡风险；然而，试验表明，身体活动，包括有组织的锻炼，对结直肠癌幸存者（局限于转移阶段、治疗期间及之后）是安全的，且能改善心肺功能和身体机能。此外，前瞻性观察性研究表明，西式饮食模式、高碳水化合物摄入以及诊断后饮用含糖饮料可能会增加结直肠癌复发和死亡风险，但这些数据仅限于来自美国两个队列之一的单项分析。需要前瞻性研究和随机对照试验的更多数据。尽管如此，根据现有证据，建议结直肠癌幸存者进行规律的身体活动，并限制精制碳水化合物、红肉、加工肉类和含糖饮料的摄入是合理的。
