Cao Yunfeng, Baumgartner Kathy B, Visvanathan Kala, Boone Stephanie D, Baumgartner Richard N, Connor Avonne E
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA.
Department of Epidemiology and Population Health and the James Graham Brown Cancer Center, University of Louisville, Louisville, KY USA.
NPJ Breast Cancer. 2020 Oct 9;6:51. doi: 10.1038/s41523-020-00194-5. eCollection 2020.
Physical activity is recommended for most cancer patients as a nonpharmacological therapy to improve prognosis. Few studies have investigated the association between physical activity and breast cancer prognosis by ethnicity, biological, and modifiable risk factors for mortality. We investigated the association between physical activity and long-term survival among breast cancer survivors. A total of 397 survivors (96 Hispanic and 301 non-Hispanic White (NHW)) from the New Mexico HEAL study contributed baseline and biological data approximately 6 months after diagnosis. Study outcomes included all-cause, breast cancer-specific, and non-breast cancer mortality. The exposure was self-reported physical activity within the past month. Multivariable hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox Proportional Hazards regression. A total of 133 deaths (53 breast cancer-specific deaths) were observed after a median follow-up time of 13 years. Engaging in >6.9 metabolic equivalent hours/week (MET-h/week) of moderate to vigorous physical activity (active) was inversely associated with all-cause mortality among all women (HR 0.66, 95% CI 0.43-0.99) and NHWs (HR 0.58, 95% CI 0.36-0.94). Active NHW women also had a reduced risk of non-breast cancer mortality (HR 0.56, 95% CI 0.31-0.99), compared to inactive women (0 MET-h/week). In subgroups, we observed the inverse associations with all-cause mortality among women >58 years old (-interaction= 0.03) and with localized stage (-interaction = 0.046). Our results confirm the protective association between physical activity and mortality after breast cancer diagnosis, and demonstrate that this association significantly differs by age and cancer stage. Larger studies are warranted to substantiate our findings.
对于大多数癌症患者，建议将体育活动作为一种非药物疗法以改善预后。很少有研究按种族、生物学因素以及可改变的死亡风险因素来调查体育活动与乳腺癌预后之间的关联。我们调查了乳腺癌幸存者中体育活动与长期生存之间的关联。新墨西哥州健康促进与癌症生存研究中的397名幸存者（96名西班牙裔和301名非西班牙裔白人（NHW））在确诊后约6个月提供了基线和生物学数据。研究结局包括全因死亡率、乳腺癌特异性死亡率和非乳腺癌死亡率。暴露因素为过去一个月内自我报告的体育活动情况。使用Cox比例风险回归估计多变量风险比（HR）和95%置信区间（CI）。在中位随访13年后，共观察到133例死亡（53例乳腺癌特异性死亡）。所有女性（HR 0.66，95% CI 0.43 - 0.99）和非西班牙裔白人（HR 0.58，95% CI 0.36 - 0.94）中，每周进行超过6.9代谢当量小时/周（MET-h/周）的中度至剧烈体育活动（活跃）与全因死亡率呈负相关。与不活动的女性（0 MET-h/周）相比，活跃的非西班牙裔白人女性非乳腺癌死亡率风险也降低（HR 0.56，95% CI 0.31 - 0.99）。在亚组分析中，我们观察到年龄大于58岁的女性（交互作用P = 0.03）和局限性分期的女性（交互作用P = 0.046）中体育活动与全因死亡率呈负相关。我们的结果证实了乳腺癌诊断后体育活动与死亡率之间的保护性关联，并表明这种关联在年龄和癌症分期上存在显著差异。需要开展更大规模的研究来证实我们的发现。
