Johansen Sara H, Wisløff Torbjørn, Edvardsen Elisabeth, Kollerud Sofie T, Jensen Johanne S S, Agwu Ginika, Matsoukas Konstantina, Scott Jessica M, Nilsen Tormod S
Department of Physical Performance, The Norwegian School of Sport Sciences, Oslo, Norway.
Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway.
JACC CardioOncol. 2025 Feb;7(2):96-106. doi: 10.1016/j.jaccao.2024.11.004. Epub 2025 Jan 14.
Poor cardiorespiratory fitness (CRF) is associated with a higher symptom burden and an increased prevalence of long-term treatment-related cardiovascular disease risk factors in cancer survivors. However, the magnitude of systemic therapy-related CRF impairment remains unclear.
The aim of this study was to evaluate the effects of systemic anticancer treatment on CRF and identify physiological determinants underpinning CRF impairment.
A systematic literature search was performed in PubMed, Embase, CINAHL, SPORTDiscus, and the Cochrane Library. The primary endpoint was the change in CRF, measured by peak oxygen consumption (Vo), from before to after systemic treatment. Secondary endpoints included post-treatment differences in Vo between cancer survivors and noncancer control subjects, along with physiological determinants of Vo. Two meta-regressions were conducted to examine the association between CRF and cardiac output and arteriovenous oxygen difference.
A total of 44 studies were included, comprising 27 prospective trials (61%; n = 1,234 cancer survivors, median age 52.4 years) and 17 cross-sectional studies (39%; n = 1,372 cancer survivors, median age 54.0 years; n = 1,923 noncancer control subjects, median age 56.0 years). Systemic anticancer treatment was associated with a significant decrease in Vo (weighted mean difference -2.13 mL·kg·min; 95% CI: -2.76 to -1.50 mL·kg·min). No significant differences were observed between patient subgroups (esophagogastric, breast, and colon or rectal cancers). At a median follow-up of 2 years (range: 6 weeks to 12 years) post-therapy, cancer survivors had a significantly lower Vo (weighted mean difference -6.39 mL·kg·min; 95% CI: -7.60 to -5.18 mL·kg·min) compared with noncancer control subjects. Reduced arteriovenous oxygen difference was associated with lower Vo (β = 2.55; 95% CI: 2.05-3.06; P < 0.001).
Systemic anticancer treatment leads to substantial and sustained impairments in CRF.
心肺适能（CRF）较差与癌症幸存者较高的症状负担以及长期治疗相关心血管疾病危险因素的患病率增加有关。然而，全身治疗相关的CRF损害程度仍不清楚。
本研究旨在评估全身抗癌治疗对CRF的影响，并确定CRF损害的生理决定因素。
在PubMed、Embase、CINAHL、SPORTDiscus和Cochrane图书馆进行了系统的文献检索。主要终点是全身治疗前后通过峰值耗氧量（Vo）测量的CRF变化。次要终点包括癌症幸存者与非癌症对照受试者之间治疗后Vo的差异，以及Vo的生理决定因素。进行了两项meta回归分析，以检验CRF与心输出量和动静脉氧差之间的关联。
共纳入44项研究，包括27项前瞻性试验（61%；n = 1234名癌症幸存者，中位年龄52.4岁）和17项横断面研究（39%；n = 1372名癌症幸存者，中位年龄54.0岁；n = 1923名非癌症对照受试者，中位年龄56.0岁）。全身抗癌治疗与Vo显著降低相关（加权平均差 -2.13 mL·kg·min；95% CI：-2.76至-1.50 mL·kg·min）。患者亚组（食管胃癌、乳腺癌和结肠癌或直肠癌）之间未观察到显著差异。在治疗后中位随访2年（范围：6周至12年）时，与非癌症对照受试者相比，癌症幸存者的Vo显著更低（加权平均差 -6.39 mL·kg·min；95% CI：-7.60至-5.18 mL·kg·min）。动静脉氧差降低与较低的Vo相关（β = 2.55；95% CI：2.05 - 3.06；P < 0.001）。
全身抗癌治疗导致CRF出现实质性且持续的损害。
