Associations of Physical Activity With Survival and Progression in Metastatic Colorectal Cancer: Results From Cancer and Leukemia Group B (Alliance)/SWOG 80405
Associations of Physical Activity With Survival and Progression in Metastatic Colorectal Cancer: Results From Cancer and Leukemia Group B (Alliance)/SWOG 80405
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DOI：
10.1200/jco.19.01019
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发表时间：
2019-10-10
影响因子：
45.3
通讯作者：
Meyerhardt, Jeffrey A.
中科院分区：
文献类型：
--
作者：
Guercio, Brendan J.;Zhang, Sui;Meyerhardt, Jeffrey A.
定期体力活动与非转移性结直肠癌患者复发和死亡风险降低相关。它对晚期/转移性结直肠癌（mCRC）患者的影响在很大程度上是unexplored.Patients和METHODS我们进行了一项前瞻性队列研究嵌套在癌症和白血病组B（联盟）/SWOG 80405（ClinicalTrials.gov标识符：NCT 00265850），国家癌症研究所？申办的全身治疗mCRC的III期试验。在治疗开始后1个月内，邀请患者完成经验证的问卷，报告过去2个月的平均体力活动。根据这些反应，我们计算了每周代谢当量任务（MET）小时数，以量化体力活动。临床试验和这项伴随研究的主要终点是总生存期（OS）。次要终点包括无进展生存期（PFS）和首个3级或更高级别的治疗相关不良事件。为了尽量减少健康状况不佳和下降的混杂因素，我们排除了在活动评估后60天内发生疾病进展或死亡的患者，并使用考克斯比例风险回归分析来调整已知的预后因素、合并症和体重减轻。与每周从事少于3个MET小时体力活动的患者相比，每周从事18个或更多MET小时体力活动的患者的OS校正风险比为0. 85（95% CI，0. 71 - 1. 02; P趋势= 0. 06），PFS校正风险比为0. 83（95% CI，0. 70 - 0. 99; P趋势= 0. 01）。与每周接受不到9小时MET的患者相比，每周接受9小时或更多MET的患者发生3级或更高级别治疗相关不良事件的校正风险比为0.73（95% CI，0.62 ~ 0.86; P趋势< .001）。结论在癌症和白血病组B的mCRC患者中，（Alliance）/SWOG 80405，体力活动与OS的相关性无统计学意义。体力活动越多，PFS越长，首次发生3级或3级以上治疗相关不良事件的校正风险越低。
PURPOSERegular physical activity is associated with reduced risk of recurrence and mortality in patients with nonmetastatic colorectal cancer. Its influence on patients with advanced/metastatic colorectal cancer (mCRC) has been largely unexplored.PATIENTS AND METHODSWe conducted a prospective cohort study nested in Cancer and Leukemia Group B (Alliance)/SWOG 80405 (ClinicalTrials.gov identifier: NCT00265850), a National Cancer Institute?sponsored phase III trial of systemic therapy for mCRC. Within 1 month after therapy initiation, patients were invited to complete a validated questionnaire that reported average physical activity over the previous 2 months. On the basis of responses, we calculated metabolic equivalent task (MET) hours per week to quantify physical activity. The primary end point of the clinical trial and this companion study was overall survival (OS). Secondary end points included progression-free survival (PFS) and first grade 3 or greater treatment-related adverse events. To minimize confounding by poor and declining health, we excluded patients who experienced progression or died within 60 days of activity assessment and used Cox proportional hazards regression analysis to adjust for known prognostic factors, comorbidities, and weight loss.RESULTSThe final cohort included 1,218 patients. Compared with patients engaged in less than 3 MET hours per week of physical activity, patients engaged in 18 or more MET hours per week experienced an adjusted hazard ratio for OS of 0.85 (95% CI, 0.71 to 1.02; P-Trend = .06) and for PFS of 0.83 (95% CI, 0.70 to 0.99; P-Trend = .01). Compared with patients engaging in less than 9 MET hours per week, patients engaging in 9 or more MET hours per week experienced an adjusted hazard ratio for grade 3 or greater treatment-related adverse events of 0.73 (95% CI, 0.62 to 0.86; P-Trend < .001).CONCLUSIONAmong patients with mCRC in Cancer and Leukemia Group B (Alliance)/SWOG 80405, association of physical activity with OS was not statistically significant. Greater physical activity was associated with longer PFS and lower adjusted risk for first grade 3 or greater treatment-related adverse events.