Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota.
Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia.
Am J Hematol. 2018 Dec;93(12):1543-1550. doi: 10.1002/ajh.25288. Epub 2018 Oct 17.
The impact of physical activity (PA) on lymphoma survival is not known. The association of PA and change in PA with overall (OS), lymphoma-specific (LSS) and event-free (EFS) survival was evaluated in a prospective cohort of newly diagnosed lymphoma patients (2002-2012). We calculated Leisure Score Indexes (mLSI) from the self-reported usual adult PA (baseline) and at 3-years post-diagnosis (FU3), grouping patients by active vs insufficiently active by the American Cancer Society PA guidelines. Associations of PA with survival were assessed using hazard ratios (HRs) and 95% confidence intervals (CI) from Cox models stratified by lymphoma subtype, adjusted for age, sex, baseline BMI, and comorbidity score with change scores further adjusted for baseline PA. Three thousand sixty participants were evaluable at baseline and 1371 at FU3. Active patients had superior survival from baseline [HR (CI): OS 0.82 (0.72-0.94); LSS 0.74 (0.61-0.90); EFS 0.92 (0.82-1.02)] and FU3 [HR (CI): OS 0.64 (0.46-0.88); LSS 0.32 (0.18-0.59); EFS 0.82 (0.61-1.10)] compared to insufficiently active. An increase in mLSI from baseline to FU3 (vs stable mLSI) was associated with superior OS (HR = 0.70, CI 0.49-1.00) and LSS (HR = 0.49, CI 0.26-0.94).The continuous change in mLSI at FU3 was significantly associated with OS, LSS and EFS; maintained across subgroups and appeared linear. Higher PA among lymphoma patients at diagnosis and 3 years is significantly associated with OS, LSS, and EFS. Increasing PA after diagnosis is significantly associated with improved OS and LSS supporting an important role for PA in lymphoma survivorship and the need for intervention trials.
目前尚不清楚体力活动（PA）对淋巴瘤生存的影响。本前瞻性队列研究纳入了 2002-2012 年间新诊断的淋巴瘤患者，评估了 PA 及其变化与总生存（OS）、淋巴瘤特异性生存（LSS）和无事件生存（EFS）之间的关系。我们根据美国癌症协会的 PA 指南，从自我报告的成年常体力活动（基线）和诊断后 3 年（FU3）计算了 Leisure Score Indexes（mLSI），将患者分为活跃组和不活跃组。使用 Cox 模型评估 PA 与生存的相关性，模型根据淋巴瘤亚型进行分层，调整了年龄、性别、基线 BMI 和合并症评分，并进一步根据基线 PA 调整了变化值。共有 3060 名患者在基线时可评估，1371 名患者在 FU3 时可评估。与不活跃患者相比，活跃患者的生存情况更佳，从基线开始[HR（CI）：OS 0.82（0.72-0.94）；LSS 0.74（0.61-0.90）；EFS 0.92（0.82-1.02）]和 FU3[HR（CI）：OS 0.64（0.46-0.88）；LSS 0.32（0.18-0.59）；EFS 0.82（0.61-1.10）]。与 mLSI 从基线到 FU3 保持稳定相比，mLSI 增加（vs 稳定 mLSI）与 OS（HR=0.70，CI 0.49-1.00）和 LSS（HR=0.49，CI 0.26-0.94）显著相关。FU3 时 mLSI 的连续变化与 OS、LSS 和 EFS 显著相关；在各亚组中均保持一致，且呈线性变化。淋巴瘤患者在诊断时和诊断后 3 年的 PA 较高与 OS、LSS 和 EFS 显著相关。诊断后 PA 的增加与 OS 和 LSS 的改善显著相关，支持 PA 在淋巴瘤生存中的重要作用，需要进行干预试验。
