Measures of physical function clarify the prognostic blur of cancer survivorship.
Measures of physical function clarify the prognostic blur of cancer survivorship.
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身体机能测量阐明了癌症生存的预后模糊性。
DOI：
10.1093/jnci/djae076
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发表时间：
2024
期刊：
影响因子：
--
通讯作者：
Brown,JustinC
中科院分区：
文献类型：
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作者：
Brown,JustinC
在整个人类进化过程中，身体机能和高效的活动能力一直是自然选择的主要重点(1)。身体机能，如走路，是一项复杂的活动，需要出生后一年的时间来发展(2)。多个生理网络，如心肺、神经系统和肌肉骨骼系统，协同工作以实现最佳的身体功能(3)。此外，这些生理网络是冗余的，因此当一个生理系统受损时，其他系统可以补偿(3)。当这些生理网络耗尽，代偿系统失效时，功能下降就会发生(4)。在癌症诊断后的第一年，癌症幸存者的身体功能相对于没有癌症的人会加速下降(5)。然而，尚不确定癌症诊断后这些功能下降是否与生存有关。在这一期的杂志上，Gonzalo-Encabo博士和他的同事们报道了癌症诊断后身体功能的下降与全因和癌症特异性死亡之间的关系。研究人员利用了来自8000多名绝经后妇女的数据，这些妇女参加了妇女健康倡议，并被诊断患有任何类型的癌症。在癌症诊断前和诊断后1年内，采用36项健康调查表（SF-36）测量身体功能。SF-36测试询问完成10项任务的难度，比如走四分之一英里或爬10级楼梯，得分范围从0到100，得分越高表明身体机能越好。主要结果是任何原因导致的死亡时间和癌症导致的死亡。重要的人口统计学、行为学和临床特征被纳入多变量回归模型；一部分参与者有详细的癌症治疗数据，并在探索性分析中进行了检查。在中位随访7.7年期间，3316名参与者死于各种原因（占分析样本的41.1%）。这项分析的主要发现是，在癌症诊断后，自我报告的身体功能每下降10%，各种原因导致的死亡风险就会增加12%。癌症诊断后的身体功能与死亡风险呈剂量-反应梯度相关，即较低的身体功能与较高的死亡风险相关。在
Physical functioning and efficient mobility have been a primary emphasis of natural selection throughout human evolution (1). Physical function, such as walking, is a complex activity that requires a year to develop after birth (2). Multiple physiologic networks, such as the cardiopulmonary, neurologic, and musculoskeletal systems, work together to enable optimal physical function (3). Moreover, these physiologic networks are redundant, so other systems can compensate when one physiologic system is compromised (3). Functional declines occur when these physiologic networks become depleted and compensatory systems fail (4). In the first year after cancer diagnosis, cancer survivors experience accelerated declines in physical function relative to individuals without cancer (5). It is uncertain, however, if these functional declines after cancer diagnosis relate to survival. In this issue of the Journal, Dr Gonzalo-Encabo and colleagues (6) report how declines in physical function after a cancer diagnosis are associated with all-cause and cancer-specific death. The investigators leveraged data from more than 8000 postmenopausal women who were enrolled in the Women’s Health Initiative and diagnosed with any type of cancer. Physical function was measured using the 36-item Short Form Health Survey (SF-36) before and within 1 year after cancer diagnosis. The SF-36 inquiries about the difficulty of completing 10 tasks, such as walking one-quarter mile or climbing 10 stairs, forming a score that ranges from zero to 100, with higher scores indicating better physical function. The primary outcomes were the time to death from any cause and death attributed to cancer. Important demographic, behavioral, and clinical characteristics were included in multivariable regression models; a subset of participants had detailed cancer treatment data available and were examined in an exploratory analysis. During a median follow-up of 7.7 years, 3316 participants died from all causes (41.1% of the analytic sample).The major finding of this analysis is that for each 10% decline in self-reported physical function after cancer diagnosis, the risk of death from all causes increased by 12%. The association of physical function after cancer diagnosis was associated with the risk of death in a dose-response gradient, such that lower physical function was associated with a higher risk of death. In