Yao Ping, Zhong Ying, Wei Zhigong
Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China.
BMC Cancer. 2025 Mar 28;25(1):570. doi: 10.1186/s12885-025-13578-2.
Sedentary behavior and depressive symptoms are commonly observed in cancer survivors. However, the combined impact of these factors on the mortality outcomes of cancer survivors remains unknown.
Cancer survivors from the National Health and Nutrition Examination Survey (NHANES) (2007-2018) were selected. Multivariate-adjusted Cox regression analyses were employed to examine the intendent and joint prognostic effects of sedentary behavior and depressive symptoms on the mortality outcomes of cancer survivors.
A total of 2,460 US adult cancer survivors (men = 1,143 and women = 1,317) were included. Severe sedentary behavior (≥ 8 h/day) was linked to higher all-cause [hazard ratio (HR) = 1.68, 95% confidence interval (CI): 1.36-2.09, p < 0.001] and noncancer mortality (HR = 1.80, 95% CI: 1.35-2.40, p < 0.001) in cancer survivors. Each additional hour of sedentary time increased the risk of all-cause (HR = 1.05, 95% CI: 1.02-1.08, p < 0.001) and noncancer mortality (HR = 1.07, 95% CI: 1.04-1.11, p < 0.001). Depressive symptoms (PHQ-9 ≥ 5) were also associated with higher all-cause (HR = 1.22, 95% CI: 1.01-1.48, p = 0.040) and noncancer mortality (HR = 1.27, 95% CI: 1.01-1.61, p = 0.045). In the joint analysis, cancer survivors with both depressive symptoms and severe sedentary behavior had the highest risk of all-cause mortality (HR = 2.06, 95% CI: 1.47-2.88, p < 0.001). Survivors with no depressive symptoms but severe sedentary behavior also had a higher risk (HR = 1.44, 95% CI: 1.10-1.88, p = 0.008). Additionally, the combination of depressive symptoms and severe sedentary behavior increased risks of cancer-specific (HR = 1.56, 95% CI: 1.04-2.34, p = 0.001), noncancer (HR = 1.86, 95% CI: 1.34-2.57, p < 0.001), and CMD-related mortality (HR = 1.74, 95% CI: 1.04-2.93, p = 0.037). In subgroup analysis, cancer survivors with endocrine-related and gastrointestinal cancers were more sensitive to these effects.
Our study highlighted the importance of considering both sedentary behavior and mental health in making effective long-term follow-up recommendations for cancer survivors.
在癌症幸存者中，久坐行为和抑郁症状很常见。然而，这些因素对癌症幸存者死亡结局的综合影响仍不清楚。
选取美国国家健康与营养检查调查（NHANES）（2007 - 2018年）中的癌症幸存者。采用多变量调整的Cox回归分析，以检验久坐行为和抑郁症状对癌症幸存者死亡结局的单独及联合预后影响。
共纳入2460名美国成年癌症幸存者（男性 = 1143名，女性 = 1317名）。严重久坐行为（≥8小时/天）与癌症幸存者的全因死亡风险升高相关[风险比（HR）= 1.68，95%置信区间（CI）：1.36 - 2.09，p < 0.001]和非癌症死亡风险升高相关（HR = 1.80，95% CI：1.35 - 2.40，p < 0.001）。久坐时间每增加1小时，全因死亡风险（HR = 1.05，95% CI：1.02 - 1.08，p < 0.001）和非癌症死亡风险（HR = 1.07，95% CI：1.04 - 1.11，p < 0.001）都会增加。抑郁症状（PHQ - 9≥5）也与全因死亡风险升高相关（HR = 1.22，95% CI：1.01 - 1.48，p = 0.040）和非癌症死亡风险升高相关（HR = 1.27，95% CI：1.01 - 1.61，p = 0.045）。在联合分析中，既有抑郁症状又有严重久坐行为的癌症幸存者全因死亡风险最高（HR = 2.06，95% CI：1.47 - 2.88，p < 0.001）。没有抑郁症状但有严重久坐行为的幸存者风险也较高（HR = 1.44，95% CI：1.10 - 1.88，p = 0.008）。此外，抑郁症状和严重久坐行为的组合会增加癌症特异性死亡（HR = 1.56，95% CI：1.04 - 2.34，p = 0.001）、非癌症死亡（HR = 1.86，95% CI：1.34 - 2.57，p < 0.001）和慢性疾病相关死亡（HR = 1.74，95% CI：1.04 - 2.93，p = 0.037）的风险。在亚组分析中，患有内分泌相关癌症和胃肠道癌症的幸存者对这些影响更为敏感。
我们的研究强调了在为癌症幸存者制定有效的长期随访建议时，同时考虑久坐行为和心理健康的重要性。
