Lai Hurong, Liao Caifeng, Tu Yansong, Yang Yazhi, Bao Wanwan, Zhang Shan, Lin Chuyang, Tu Huaijun, He Ling, Li Jian
Key Laboratory of Hematology of Jiangxi Province, Department of Hematology, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Jiangxi, 330000, China.
Faculty of Science, University of Melbourne, Parkville, 3052, Australia.
J Transl Med. 2025 Nov 7;23(1):1241. doi: 10.1186/s12967-025-07186-8.
Frailty and unfavorable lifestyle factors are associated with elevated cancer risk. However, whether adherence to a healthy lifestyle is associated with a reduction in frailty-related cancer risk remains unclear. This study aimed to examine the associations between frailty, healthy lifestyle, and overall cancer risk, and to assess the extent to which a healthy lifestyle is correlated with attenuated risks of overall and site-specific cancers associated with frailty.
This prospective cohort study utilized data from the China Kadoorie Biobank (CKB), enrolling 484,225 adults aged 30-79 years from 10 geographically diverse regions across China. The frailty index (FI) was calculated using 28 baseline variables, all of which represented health status deficits measured through questionnaires and physical examinations. Lifestyle behaviors were determined by smoking status, alcohol consumption, physical activity, diet score, and body shape. The primary outcome was incidence of all cancer types during follow-up (ICD-10: C00-C97). Multivariable-adjusted Cox proportional hazards regression models were used to evaluate associations between frailty, healthy lifestyle, and cancer risk.
Among 484,225 participants in the China Kadoorie Biobank cohort, 288,531 (59.6%) were women. After 4,774,217 person-years of follow-up, 21,459 incident cancer cases were identified. Participants with high frailty showed significantly increased risk of overall cancer (hazard ratio [HR] 1.31, 95% confidence interval [CI] 1.23-1.38). Conversely, adherence to a favorable lifestyle was associated with reduced cancer risk (HR 0.74, 95% CI 0.71-0.78). Additive interaction analysis demonstrated a significant negative interaction between frailty and favorable lifestyle regarding overall cancer risk (RERI: - 0.50, 95% CI: - 0.75, - 0.24). Most notably, we found that adherence to a healthy lifestyle was significantly associated with a reduction in the detrimental effects of frailty on overall cancer risk. Specifically, Participants with robust status and a favorable lifestyle exhibited the lowest cancer risk (HR 0.57, 95% CI 0.51-0.63, P < 0.001). Furthermore, similar protective associations were observed for site-specific cancers, including lung, colorectal, and liver cancers.
In this large-scale prospective cohort study of Chinese adults, we demonstrated that adherence to a healthy lifestyle was significantly associated with a reduced risk of frailty-related cancer. Our findings highlight the importance of integrating healthy lifestyle factors into cancer prevention strategies for frail populations.
衰弱和不良生活方式因素与癌症风险升高相关。然而，坚持健康的生活方式是否与降低衰弱相关的癌症风险仍不清楚。本研究旨在探讨衰弱、健康生活方式与总体癌症风险之间的关联，并评估健康生活方式与衰弱相关的总体和特定部位癌症风险降低之间的相关程度。
这项前瞻性队列研究使用了中国慢性病前瞻性研究（CKB）的数据，纳入了来自中国10个不同地理区域的484225名30-79岁的成年人。使用28个基线变量计算衰弱指数（FI），所有这些变量均代表通过问卷调查和体格检查测得的健康状况缺陷。生活方式行为由吸烟状况、饮酒、身体活动、饮食评分和体型决定。主要结局是随访期间所有癌症类型的发病率（国际疾病分类第十版：C00-C97）。多变量调整的Cox比例风险回归模型用于评估衰弱、健康生活方式与癌症风险之间的关联。
在中国慢性病前瞻性研究队列的484225名参与者中，288531名（59.6%）为女性。经过4774217人年的随访，确定了21459例新发癌症病例。衰弱程度高的参与者总体癌症风险显著增加（风险比[HR]1.31，95%置信区间[CI]1.23-1.38）。相反，坚持良好的生活方式与降低癌症风险相关（HR 0.74，95%CI 0.71-0.78）。相加交互作用分析表明，在总体癌症风险方面，衰弱与良好生活方式之间存在显著的负交互作用（相对超额危险度增量：-0.50，95%CI：-0.75，-0.24）。最值得注意的是，我们发现坚持健康的生活方式与减轻衰弱对总体癌症风险的有害影响显著相关。具体而言，身体状况良好且生活方式良好的参与者癌症风险最低（HR 0.57，95%CI 0.51-0.63，P<0.001）。此外，在包括肺癌、结直肠癌和肝癌在内的特定部位癌症中也观察到了类似的保护关联。
在这项针对中国成年人的大规模前瞻性队列研究中，我们证明坚持健康的生活方式与降低衰弱相关癌症的风险显著相关。我们的研究结果强调了将健康生活方式因素纳入衰弱人群癌症预防策略的重要性。
