新辅助化疗期间进行运动预康复可能会增强食管癌的肿瘤退缩：一项前瞻性非随机试验的结果

Exercise prehabilitation during neoadjuvant chemotherapy may enhance tumour regression in oesophageal cancer: results from a prospective non-randomised trial.

作者信息

Zylstra Janine, Whyte Greg P, Beckmann Kerri, Pate James, Santaolalla Aida, Gervais-Andre Louise, Russell Beth, Maisey Nick, Waters Justin, Tham Gemma, Lagergren Jesper, Green Michael, Kelly Mark, Baker Cara, Van Hemelrijck Mieke, Goh Vicky, Gossage James, Browning Mike, Davies Andrew

机构信息

Gastrointestinal Medicine and Surgery, Guy's and St Thomas' Hospitals NHS Trust, London, UK.

School of Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK.

出版信息

Br J Sports Med. 2022 Apr;56(7):402-409. doi: 10.1136/bjsports-2021-104243. Epub 2022 Feb 1.

DOI:10.1136/bjsports-2021-104243

PMID:35105604

Abstract

BACKGROUND

There is increasing evidence for the use of exercise in cancer patients and data supporting enhanced tumour volume reduction following chemotherapy in animal models. To date, there is no reported histopathological evidence of a similar oncological benefit in oesophageal cancer.

METHODS

A prospective non-randomised trial compared a structured prehabilitation exercise intervention during neoadjuvant chemotherapy and surgery versus conventional best-practice for oesophageal cancer patients. Biochemical and body composition analyses were performed at multiple time points. Outcome measures included radiological and pathological markers of disease regression. Logistic regression calculated ORs with 95% CI for the likelihood of pathological response adjusting for chemotherapy regimen and chemotherapy delivery.

RESULTS

Comparison of the Intervention (n=21) and Control (n=19) groups indicated the Intervention group had higher rates of tumour regression (Mandard TRG 1-3 Intervention n=15/20 (75%) vs Control n=7/19 (36.8%) p=0.025) including adjusted analyses (OR 6.57; 95% CI 1.52 to 28.30). Combined tumour and node downstaging (Intervention n=9 (42.9%) vs Control n=3 (15.8%) p=0.089) and Fat Free Mass index were also improved (Intervention 17.8 vs 18.7 kg/m; Control 16.3 vs 14.7 kg/m, p=0.026). Differences in markers of immunity (CD-3 and CD-8) and inflammation (IL-6, VEGF, INF-y, TNFa, MCP-1 and EGF) were observed.

CONCLUSION

The results suggest improved tumour regression and downstaging in the exercise intervention group and should prompt larger studies on this topic.

TRIAL REGISTRATION NUMBER

NCT03626610.

摘要

背景

越来越多的证据表明运动对癌症患者有益，并且在动物模型中有数据支持运动可增强化疗后肿瘤体积的缩小。迄今为止，尚无关于食管癌类似肿瘤学益处的组织病理学证据报道。

方法

一项前瞻性非随机试验比较了新辅助化疗和手术期间结构化的术前康复运动干预与食管癌患者的传统最佳治疗方法。在多个时间点进行了生化和身体成分分析。结果指标包括疾病消退的放射学和病理学标志物。逻辑回归计算了调整化疗方案和化疗给药后病理反应可能性的比值比（OR）及95%置信区间。

结果

干预组（n = 21）和对照组（n = 19）的比较表明，干预组的肿瘤消退率更高（曼德尔肿瘤退缩分级1 - 3级：干预组n = 15/20（75%），对照组n = 7/19（36.8%），p = 0.025），包括调整分析（OR 6.57；95%置信区间1.52至28.30）。肿瘤和淋巴结降期合并情况（干预组n = 9（42.9%），对照组n = 3（15.8%），p = 0.089）以及去脂体重指数也有所改善（干预组17.8对18.7kg/m²；对照组16.3对14.7kg/m²，p = 0.026）。观察到免疫标志物（CD - 3和CD - 8）和炎症标志物（IL - 6、VEGF、INF - γ、TNFα、MCP - 1和EGF）存在差异。