早期乳腺癌治疗后体育锻炼的效果：系统评价和荟萃分析。
Effects of physical exercise after treatment of early breast cancer: systematic review and meta-analysis.
机构信息
Pathology Post-Graduate Program - Universidade Federal de Ciências da Saúde de Porto Alegre, 245, Sarmento Leite Street - Centro Histórico, Porto Alegre, RS, 90050-170, Brazil.
Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
出版信息
Breast Cancer Res Treat. 2018 Aug;170(3):455-476. doi: 10.1007/s10549-018-4786-y. Epub 2018 Apr 13.
PURPOSE
Randomized clinical trials are inconclusive regarding the role of physical exercise in anthropometric measurements, quality of life, and survival in breast cancer patients. Our aim was to conduct a systematic review and meta-analysis to assess the effects of physical exercise on these outcomes in women who went through curative treatment of early-stage breast cancer.
METHODS
Pubmed, Embase, Cochrane Library were searched for randomized clinical trial comparing physical exercise (counseling or structured programs with supervised/individualized exercise sessions) with usual care in women that went through for breast cancer treatment. Primary outcomes were overall survival and disease-free survival, while secondary outcomes were weight loss, body mass index, waist-hip ratio, percentage of body fat, and quality of life.
RESULTS
We found 60 randomized clinical trials, only one of them showed mortality data; the HR for mortality was 0.45 (95% CI 0.21-0.97) for the intervention group when compared to the control group. Physical exercise was associated with weight reduction (- 1.36 kg, 95% CI - 2.51 to - 0.21, p = 0.02), lower body mass index (- 0.89 kg/m, 95% CI - 1.50 to - 0.28, p < 0.01), and lower percentage of body fat (- 1.60 percentage points, 95% CI - 2.31 to - 0.88, p < 0.01). There was an increase in the quality of life (standardized mean difference of 0.45, 95% CI 0.20-0.69, p < 0.01).
CONCLUSIONS
The articles found had heterogeneous types of intervention, but they showed significant effects on anthropometric measures and quality of life. Among them, only one study had mortality as outcome and it showed physical exercise as a protective intervention. Despite these findings, publication bias and poor methodological quality were presented. Physical exercise should be advised for breast cancer survivors since it has no adverse effects and can improve anthropometrics measures and quality of life. PROSPERO registry: CRD42014008743.
目的
随机临床试验对于体育锻炼在乳腺癌患者的人体测量学指标、生活质量和生存方面的作用尚无定论。我们的目的是进行系统评价和荟萃分析，以评估体育锻炼对接受早期乳腺癌根治性治疗的女性这些结局的影响。
方法
检索 Pubmed、Embase 和 Cochrane Library，比较了接受乳腺癌治疗的女性接受体育锻炼（咨询或有监督/个体化运动课程的结构化方案）与常规护理的随机临床试验。主要结局为总生存率和无病生存率，次要结局为体重减轻、体重指数、腰臀比、体脂百分比和生活质量。
结果
我们发现了 60 项随机临床试验，其中只有 1 项显示了死亡率数据；与对照组相比，干预组的死亡率为 0.45（95%可信区间 0.21-0.97）。体育锻炼与体重减轻（-1.36kg，95%可信区间-2.51 至-0.21，p=0.02）、体重指数降低（-0.89kg/m，95%可信区间-1.50 至-0.28，p<0.01）和体脂百分比降低（-1.60 个百分点，95%可信区间-2.31 至-0.88，p<0.01）有关。生活质量也有所提高（标准化均数差为 0.45，95%可信区间 0.20-0.69，p<0.01）。
结论
所发现的文章干预类型各异，但对人体测量指标和生活质量均有显著影响。其中，只有一项研究将死亡率作为结局，显示体育锻炼是一种保护干预措施。尽管存在这些发现，但仍存在发表偏倚和低方法学质量的问题。由于体育锻炼没有不良反应，并且可以改善人体测量学指标和生活质量，因此应该建议乳腺癌幸存者进行体育锻炼。PROSPERO 注册号：CRD42014008743。
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