Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA.
Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA.
J Natl Cancer Inst. 2021 Jan 4;113(1):54-63. doi: 10.1093/jnci/djaa046.
Although physical activity has been consistently associated with reduced breast cancer mortality, evidence is largely based on data collected at one occasion. We examined how pre- and postdiagnosis physical activity was associated with survival outcomes in high-risk breast cancer patients.
Included were 1340 patients enrolled in the Diet, Exercise, Lifestyle and Cancer Prognosis (DELCaP) Study, a prospective study of lifestyle and prognosis ancillary to a SWOG clinical trial (S0221). Activity before diagnosis, during treatment, and at 1- and 2-year intervals after enrollment was collected. Patients were categorized according to the Physical Activity Guidelines for Americans as meeting the minimum guidelines (yes/no) and incrementally as inactive, low active, moderately active (meeting the guidelines), or high active.
In joint-exposure analyses, patients meeting the guidelines before and 1 year after diagnosis experienced statistically significant reductions in hazards of recurrence (hazard ratio [HR] = 0.59, 95% confidence interval [CI] = 0.42 to 0.82) and mortality (HR = 0.51, 95% CI = 0.34-0.77); associations were stronger at 2-year follow-up for recurrence (HR = 0.45, 95% CI = 0.31 to 0.65) and mortality (HR = 0.32, 95% CI = 0.19 to 0.52). In time-dependent analyses, factoring in activity from all time points, we observed striking associations with mortality for low- (HR = 0.41, 95% CI = 0.24 to 0.68), moderate- (HR = 0.42, 95% CI = 0.23 to 0.76), and high-active patients (HR = 0.31, 95% CI = 0.18 to 0.53).
Meeting the minimum guidelines for physical activity both before diagnosis and after treatment appears to be associated with statistically significantly reduced hazards of recurrence and mortality among breast cancer patients. When considering activity from all time points, including during treatment, lower volumes of regular activity were associated with similar overall survival advantages as meeting and exceeding the guidelines.
尽管身体活动一直与降低乳腺癌死亡率相关，但证据主要基于单次采集的数据。我们研究了高危乳腺癌患者在诊断前后的身体活动与生存结果的关系。
纳入了 1340 名参与饮食、运动、生活方式和癌症预后（DELCaP）研究的患者，这是一项对生活方式和辅助 SWOG 临床试验（S0221）预后的前瞻性研究。在诊断前、治疗期间以及入组后 1 年和 2 年的时间间隔内采集活动数据。患者根据美国身体活动指南分为满足最低指南（是/否）和不活动、低活动、适度活动（符合指南）和高活动。
在联合暴露分析中，在诊断前和诊断后 1 年满足指南的患者，复发的危险比（HR）分别显著降低（HR=0.59，95%置信区间[CI]为 0.42 至 0.82）和死亡率（HR=0.51，95%CI=0.34 至 0.77）；在 2 年随访时，复发的相关性更强（HR=0.45，95%CI=0.31 至 0.65）和死亡率（HR=0.32，95%CI=0.19 至 0.52）。在时间依赖性分析中，考虑所有时间点的活动，我们观察到低活动（HR=0.41，95%CI=0.24 至 0.68）、中活动（HR=0.42，95%CI=0.23 至 0.76）和高活动患者（HR=0.31，95%CI=0.18 至 0.53）死亡率的显著关联。
在诊断前和治疗后均满足身体活动的最低指南似乎与乳腺癌患者复发和死亡率的风险显著降低相关。当考虑所有时间点的活动，包括治疗期间的活动时，较低的常规活动量与满足和超过指南的总生存优势相当。
