Physical Activity Before, During, and After Chemotherapy for High-Risk Breast Cancer: Relationships With Survival
Physical Activity Before, During, and After Chemotherapy for High-Risk Breast Cancer: Relationships With Survival
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DOI：
10.1093/jnci/djaa046
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发表时间：
2021-01-01
影响因子：
10.3
通讯作者：
Ambrosone, Christine B.
中科院分区：
文献类型：
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作者：
Cannioto, Rikki A.;Hutson, Alan;Ambrosone, Christine B.
背景 尽管体力活动一直与降低乳腺癌死亡率相关，但证据主要基于一次收集的数据。我们研究了诊断前和诊断后的体力活动与高危乳腺癌患者的生存结果之间的关系。方法纳入了 1340 名患者，参加了饮食、运动、生活方式和癌症预后 (DELCaP) 研究，这是一项与 SWOG 临床试验 (S0221) 相关的生活方式和预后前瞻性研究。收集诊断前、治疗期间以及入组后每隔 1 年和 2 年的活动。根据美国人体力活动指南，患者被分类为满足最低指南（是/否），并逐渐分为不活动、低度活动、中等活动（符合指南）或高活动。 结果 在联合暴露分析中，诊断前和诊断后 1 年符合指南的患者复发风险（风险比 [HR]=0.59，95% 置信区间 [CI] = 0.42 至 0.82）和死亡率显着降低。 （HR=0.51，95% CI=0.34-0.77）； 2 年随访时，复发（HR=0.45，95% CI = 0.31 至 0.65）和死亡率（HR=0.32，95% CI = 0.19 至 0.52）之间的相关性更强。在时间依赖性分析中，考虑到所有时间点的活动，我们观察到低活动患者（HR = 0.41，95% CI = 0.24 至 0.68）、中活动患者（HR = 0.42，95% CI = 0.23 至 0.76）和高活动患者（HR = 0.31，95% CI = 0.18 至 0.76）与死亡率存在显着相关性。 0.53）。结论在诊断前和治疗后满足最低体力活动指南似乎与乳腺癌患者复发和死亡风险统计显着降低相关。当考虑所有时间点（包括治疗期间）的活动时，较低的常规活动量与达到和超过指南相似的总体生存优势相关。
Background Although physical activity has been consistently associated with reduced breast cancer mortality, evidence is largely based on data collected at one occasion. We examined how pre- and postdiagnosis physical activity was associated with survival outcomes in high-risk breast cancer patients.Methods Included were 1340 patients enrolled in the Diet, Exercise, Lifestyle and Cancer Prognosis (DELCaP) Study, a prospective study of lifestyle and prognosis ancillary to a SWOG clinical trial (S0221). Activity before diagnosis, during treatment, and at 1- and 2-year intervals after enrollment was collected. Patients were categorized according to the Physical Activity Guidelines for Americans as meeting the minimum guidelines (yes/no) and incrementally as inactive, low active, moderately active (meeting the guidelines), or high active.Results In joint-exposure analyses, patients meeting the guidelines before and 1 year after diagnosis experienced statistically significant reductions in hazards of recurrence (hazard ratio [HR]=0.59, 95% confidence interval [CI] = 0.42 to 0.82) and mortality (HR=0.51, 95% CI = 0.34-0.77); associations were stronger at 2-year follow-up for recurrence (HR=0.45, 95% CI = 0.31 to 0.65) and mortality (HR=0.32, 95% CI = 0.19 to 0.52). In time-dependent analyses, factoring in activity from all time points, we observed striking associations with mortality for low- (HR = 0.41, 95% CI = 0.24 to 0.68), moderate- (HR = 0.42, 95% CI = 0.23 to 0.76), and high-active patients (HR=0.31, 95% CI = 0.18 to 0.53).Conclusions Meeting the minimum guidelines for physical activity both before diagnosis and after treatment appears to be associated with statistically significantly reduced hazards of recurrence and mortality among breast cancer patients. When considering activity from all time points, including during treatment, lower volumes of regular activity were associated with similar overall survival advantages as meeting and exceeding the guidelines.