Memorial Sloan Kettering Cancer Center, New York, NY.
Department of Human Genetics, University of California, Los Angeles, Los Angeles, CA.
J Clin Oncol. 2023 Nov 10;41(32):4982-4992. doi: 10.1200/JCO.23.00058. Epub 2023 Aug 31.
The impact of postdiagnosis exercise on cause-specific mortality in cancer survivors and whether this differs on the basis of cancer site is unclear.
We performed an analysis of 11,480 patients with cancer enrolled in the Prostate, Lung, Colorectal, and Ovarian cancer screening trial. Patients with a confirmed diagnosis of cancer completing a standardized survey quantifying exercise after diagnosis were included. The primary outcome was all-cause mortality (ACM); secondary end points were cancer mortality and mortality from other causes. Cox models were used to estimate the cause-specific hazard ratios (HRs) for ACM, cancer, and noncancer mortality as a function of meeting exercise guidelines versus not meeting guidelines with adjustment for important clinical covariates.
After a median follow-up of 16 years from diagnosis, 4,665 deaths were documented (1,940 due to cancer and 2,725 due to other causes). In multivariable analyses, exercise consistent with guidelines was associated with a 25% reduced risk of ACM compared with nonexercise (HR, 0.75; 95% CI, 0.70 to 0.80). Compared with nonexercise, exercise consistent with guidelines was associated with a significant reduction in cancer mortality (HR, 0.79; 95% CI, 0.72 to 0.88) and mortality from other causes (HR, 0.72; 95% CI, 0.66 to 0.78). The inverse relationship between exercise and cause-specific mortality varied by exercise dose. Exercise consistent with guidelines was associated with a reduced hazard of ACM for multiple cancer sites. Reduction in cancer mortality for exercisers was only observed in head and neck and renal cancer.
In this pan-cancer sample of long-term cancer survivors, exercise consistent with guidelines was associated with substantial ACM benefit driven by both reductions in cancer and noncancer mortality. The cause-specific impact of exercise differed as a function of cancer site.
诊断后运动对癌症幸存者特定原因死亡率的影响，以及这种影响是否因癌症部位的不同而不同，目前尚不清楚。
我们对参加前列腺癌、肺癌、结直肠癌和卵巢癌筛查试验的 11480 名癌症患者进行了分析。纳入了完成标准化调查、量化诊断后运动的癌症患者。主要结局是全因死亡率（ACM）；次要终点是癌症死亡率和其他原因死亡率。使用 Cox 模型估计符合运动指南与不符合运动指南的 ACM、癌症和非癌症死亡率的特定原因风险比（HR），并调整重要临床协变量。
从诊断后中位随访 16 年开始，共记录了 4665 例死亡（1940 例死于癌症，2725 例死于其他原因）。多变量分析显示，与不运动相比，符合指南的运动与 ACM 风险降低 25%相关（HR，0.75；95%CI，0.70 至 0.80）。与不运动相比，符合指南的运动与癌症死亡率显著降低相关（HR，0.79；95%CI，0.72 至 0.88）和其他原因死亡率降低相关（HR，0.72；95%CI，0.66 至 0.78）。运动与特定原因死亡率之间的反比关系因运动剂量而异。符合指南的运动与多种癌症部位 ACM 风险降低相关。仅在头颈部和肾癌患者中观察到运动者癌症死亡率降低。
在这项长期癌症幸存者的泛癌样本中，与指南一致的运动与 ACM 获益显著相关，这主要是由于癌症和非癌症死亡率的降低。运动对特定原因死亡率的影响因癌症部位而异。
