Department of Cancer Prevention & Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York.
Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, New York.
JAMA Netw Open. 2023 May 1;6(5):e2311673. doi: 10.1001/jamanetworkopen.2023.11673.
The American Institute for Cancer Research and American Cancer Society regularly publish modifiable lifestyle recommendations for cancer prevention. Whether these recommendations have an impact on high-risk breast cancer survival remains unknown.
To investigate whether adherence to cancer prevention recommendations before, during, and 1 and 2 years after breast cancer treatment was associated with disease recurrence or mortality.
DESIGN, SETTING, AND PARTICIPANTS: The Diet, Exercise, Lifestyles, and Cancer Prognosis Study (DELCaP) was a prospective, observational cohort study designed to assess lifestyles before diagnosis, during treatment, and at 1 and 2 years after treatment completion, implemented ancillary to the Southwest Oncology Group (SWOG) S0221 trial, a multicenter trial that compared chemotherapy regimens in breast cancer. Participants were chemotherapy-naive patients with pathologic stage I to III high-risk breast cancer, defined as node-positive disease with hormone receptor-negative tumors larger than 1 cm or any tumor larger than 2 cm. Patients with poor performance status and comorbidities were excluded from S0221. The study was conducted from January 1, 2005, to December 31, 2010; mean (SD) follow-up time for those not experiencing an event was 7.7 (2.1) years through December 31, 2018. The analyses reported herein were performed from March 2022 to January 2023.
An aggregated lifestyle index score comprising data from 4 time points and 7 lifestyles, including (1) physical activity, (2) body mass index, (3) fruit and vegetable consumption, (4) red and processed meat intake, (5) sugar-sweetened beverage consumption, (6) alcohol consumption, and (7) smoking. Higher scores indicated healthier lifestyle.
Disease recurrence and all-cause mortality.
A total of 1340 women (mean [SD] age, 51.3 [9.9] years) completed the baseline questionnaire. Most patients were diagnosed with hormone-receptor positive breast cancer (873 [65.3%]) and completed some education beyond high school (954 [71.2%]). In time-dependent multivariable analyses, patients with highest vs lowest lifestyle index scores experienced a 37.0% reduction in disease recurrence (hazard ratio, 0.63; 95% CI, 0.48-0.82) and a 58.0% reduction in mortality (hazard ratio, 0.42; 95% CI, 0.30-0.59).
In this observational study of patients with high-risk breast cancer, strongest collective adherence to cancer prevention lifestyle recommendations was associated with significant reductions in disease recurrence and mortality. Education and implementation strategies to help patients adhere to cancer prevention recommendations throughout the cancer care continuum may be warranted in breast cancer.
美国癌症研究所和美国癌症协会定期发布可改变的生活方式建议，以预防癌症。这些建议是否对高危乳腺癌的生存有影响尚不清楚。
研究在乳腺癌治疗前、治疗期间以及治疗后 1 年和 2 年，是否坚持癌症预防建议与疾病复发或死亡有关。
设计、地点和参与者：饮食、运动、生活方式和癌症预后研究（DELCaP）是一项前瞻性、观察性队列研究，旨在评估诊断前、治疗期间以及治疗完成后 1 年和 2 年的生活方式，作为西南肿瘤组（SWOG）S0221 试验的辅助研究，该试验比较了乳腺癌的化疗方案。参与者是病理分期 I 至 III 期高危乳腺癌的化疗初治患者，定义为激素受体阴性肿瘤大于 1 厘米或任何肿瘤大于 2 厘米的淋巴结阳性疾病。身体状况不佳和合并症的患者被排除在 S0221 之外。该研究于 2005 年 1 月 1 日至 2010 年 12 月 31 日进行；截至 2018 年 12 月 31 日，未发生事件的患者的中位（SD）随访时间为 7.7（2.1）年。本文的分析于 2022 年 3 月至 2023 年 1 月进行。
一个由 4 个时间点和 7 种生活方式组成的综合生活方式指数评分，包括（1）体力活动，（2）体重指数，（3）水果和蔬菜摄入，（4）红色和加工肉类摄入，（5）含糖饮料摄入，（6）酒精摄入，（7）吸烟。较高的分数表示更健康的生活方式。
疾病复发和全因死亡率。
共有 1340 名女性（平均[SD]年龄，51.3[9.9]岁）完成了基线问卷。大多数患者被诊断为激素受体阳性乳腺癌（873 [65.3%]），并完成了高中以上的一些教育（954 [71.2%]）。在时间依赖性多变量分析中，生活方式指数评分最高与最低的患者疾病复发风险降低 37.0%（风险比，0.63；95%CI，0.48-0.82），死亡率降低 58.0%（风险比，0.42；95%CI，0.30-0.59）。
在这项对高危乳腺癌患者的观察性研究中，最强的集体遵守癌症预防生活方式建议与疾病复发和死亡率的显著降低相关。在乳腺癌中，可能需要教育和实施策略来帮助患者在癌症治疗全过程中坚持癌症预防建议。
