Zhu Chunsu, Lian Zhiwei, Arndt Volker, Thong Melissa S Y
Unit of Cancer Survivorship, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.
Medical Faculty, University of Heidelberg, Heidelberg, Germany.
Support Care Cancer. 2024 Dec 2;32(12):846. doi: 10.1007/s00520-024-09049-2.
Lifestyle factors in cancer survivors are frequently studied individually even though they are often interconnected. This systematic review and meta-analysis investigated the association of combined lifestyle factors on health outcomes among cancer survivors.
EMBASE, PubMed and Web of Science were searched up to March 2024. Cohort studies examining the associations of at least three combined lifestyle factors with mortality (all-cause/cancer-specific) and cardiovascular disease (CVD) among cancer survivors, were selected. Pooled hazard ratios (pHRs) and 95% confidence intervals (CIs) were estimated using random effects models. Tests for heterogeneity and publication bias were conducted.
Twenty-two studies involving 209,659 survivors with an average follow-up duration ranging from 4.1 to 29.1 years were included. pHRs(95%CI) comparing cancer survivors with the healthiest lifestyles versus those with the least healthy lifestyles were 0.57 (0.51-0.65) for all-cause mortality, 0.70 (0.61-0.80) for cancer-specific mortality, and 0.53 (0.46-0.63) for CVD incidence. These associations were largely consistent across subgroup analyses. Colorectal cancer survivors with the healthiest lifestyle experienced 37% lower all-cause mortality and 25% lower cancer-specific mortality, while breast cancer survivors had a 45% reduction in all-cause mortality. Although studies were limited, significant associations for all-cause mortality were observed among lung, liver, nasopharyngeal, gastric, kidney, gynecologic cancer survivors. However, no significant relationship between healthy lifestyles and CVD-specific mortality was detected.
Having an overall healthy lifestyle is associated with lower CVD incidence and better survival among cancer survivors. The long-term management of cancer survivors should consider encouragement for a modification of multiple lifestyles.
癌症幸存者的生活方式因素虽常相互关联，但常被单独研究。本系统评价和荟萃分析调查了综合生活方式因素与癌症幸存者健康结局之间的关联。
检索截至2024年3月的EMBASE、PubMed和Web of Science数据库。选择队列研究，这些研究考察了至少三种综合生活方式因素与癌症幸存者死亡率（全因/癌症特异性）和心血管疾病（CVD）之间的关联。使用随机效应模型估计合并风险比（pHRs）和95%置信区间（CIs）。进行异质性检验和发表偏倚检验。
纳入了22项研究，涉及209,659名幸存者，平均随访时间为4.1至29.1年。比较生活方式最健康与最不健康的癌症幸存者，全因死亡率的pHRs（95%CI）为0.57（0.51 - 0.65），癌症特异性死亡率为0.70（0.61 - 0.80），CVD发病率为0.53（0.46 - 0.63）。这些关联在亚组分析中基本一致。生活方式最健康的结直肠癌幸存者全因死亡率降低37%，癌症特异性死亡率降低25%，而乳腺癌幸存者全因死亡率降低45%。尽管研究有限，但在肺癌、肝癌、鼻咽癌、胃癌、肾癌、妇科癌症幸存者中观察到了全因死亡率的显著关联。然而，未检测到健康生活方式与CVD特异性死亡率之间的显著关系。
总体健康的生活方式与癌症幸存者较低的CVD发病率和更好的生存率相关。癌症幸存者的长期管理应考虑鼓励改变多种生活方式。
