Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia.
Faculty of Health Disciplines, Athabasca University, Athabasca, Alberta, Canada.
Cancer. 2020 Feb 15;126(4):861-869. doi: 10.1002/cncr.32578. Epub 2019 Nov 12.
High levels of sedentary behavior may negatively affect health outcomes in cancer survivors. A systematic review and meta-analysis was performed to clarify whether postdiagnosis sedentary behavior is related to survival, patient-reported outcomes, and anthropometric outcomes in cancer survivors.
The Ovid MEDLINE, EMBASE, CINAHL (The Cumulative Index to Nursing and Allied Health Literature), and SPORTDiscus databases were searched from study inception to June 2019. Studies of adults who had been diagnosed with cancer that examined the association between sedentary behavior and mortality, patient-reported outcomes (eg, fatigue, depression), or anthropometric outcomes (eg, body mass index, waist circumference) were eligible for inclusion. Meta-analyses were performed to estimate hazard ratios for the highest compared with the lowest levels of sedentary behavior for all-cause and colorectal cancer-specific mortality outcomes. The ROBINS-E (Risk of Bias in Nonrandomized Studies-of Exposures tool) and the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) system were used to assess the risk of bias and the strength of evidence, respectively.
Thirty-three eligible publications from a total of 3569 identified articles were included in the review. A higher level of postdiagnosis sedentary behavior was associated with an increased risk of all-cause mortality (hazard ratio, 1.22; 95% CI, 1.06-1.41; heterogeneity [I statistic], 33.8%) as well as colorectal cancer-specific mortality (hazard ratio, 1.53; 95% CI, 1.14-2.06; I , 0%). No clear or consistent associations between sedentary behavior and patient-reported or anthropometric outcomes were identified. The risk of bias in individual studies ranged from moderate to serious, and the strength of evidence ranged from very low to low.
Although avoiding high levels of sedentary behavior after a cancer diagnosis may improve survival, further research is required to help clarify whether the association is causal.
高久坐行为水平可能对癌症幸存者的健康结果产生负面影响。本系统评价和荟萃分析旨在阐明癌症幸存者的诊断后久坐行为是否与生存、患者报告的结局和人体测量学结局有关。
从研究开始到 2019 年 6 月，检索 Ovid MEDLINE、EMBASE、CINAHL（护理和联合健康文献累积索引）和 SPORTDiscus 数据库。合格研究为观察性研究，纳入对象为诊断为癌症的成年人，评估久坐行为与死亡率、患者报告的结局（如疲劳、抑郁）或人体测量学结局（如体重指数、腰围）之间的关联。荟萃分析用于估计最高与最低久坐行为水平与全因和结直肠癌特异性死亡率结局的风险比。使用 ROBINS-E（暴露非随机研究风险评估工具）和 GRADE（推荐评估、制定与评价系统）评估偏倚风险和证据强度。
从总共 3569 篇确定的文章中，有 33 篇符合纳入标准的文献被纳入综述。较高的诊断后久坐行为水平与全因死亡率（风险比，1.22；95%置信区间，1.06-1.41；异质性[I 统计量]，33.8%）以及结直肠癌特异性死亡率（风险比，1.53；95%置信区间，1.14-2.06；I ，0%）的增加相关。没有发现久坐行为与患者报告或人体测量学结局之间存在明确或一致的关联。个别研究的偏倚风险从中度到严重不等，证据强度从极低到低不等。
尽管癌症诊断后避免高久坐行为水平可能会改善生存，但需要进一步研究以帮助阐明这种关联是否具有因果关系。
