论文标题：Pre- to postdiagnosis leisure-time physical activity and prognosis in postmenopausal breast cancer survivors

期刊：Breast Cancer Research

作者：Audrey Y. Jung, Sabine Behrens et al.

发表时间：2019/11/07

DOI：10.1186/s13058-019-1206-0

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最近发表在开放获取期刊Breast Cancer Research 上的一项研究表明，绝经后乳腺癌患者在确诊后如果每周至少进行150分钟中等强度的体力活动（如快步走），全因死亡率就会下降，这种下降不受患者诊断前体力活动水平的影响。

尽管学界已经认识到诊断前及诊断后进行体力活动的好处，但鲜有研究考察过乳腺癌诊断后体力活动水平的变化是否会影响死亡率。海德堡德国癌症中心的研究人员调查了在德国被诊断出第一原发癌症的绝经后妇女其诊断前和诊断后的体力活动与疾病预后之间的关系。

研究的通讯作者Andrey Jung说：“我们的研究结果表明，乳腺癌病人进行休闲运动是有益处的，且这种运动相关的益处不仅限于那些诊断前后都运动的女性，还会延伸到那些诊断前运动量达不到指南推荐水平、但诊断后达到标准的女性。”

研究人员发现，与诊断前后运动量均不足（即每周中等强度运动时间少于150分钟）的女性相比，诊断前运动不足但确诊后足量运动的女性全因死亡率（即总死亡率）更低。对于诊断前每周进行中等强度休闲运动时间等于或少于150分钟的女性而言，诊断后将中等强度运动的时间提升到每周150分钟或以上，可使她们的全因死亡风险降低50%。与那些诊断前后均不进行任何休闲运动（即每周中等强度休闲运动时间为0分钟）的女性相比，诊断前后运动量均很充足的女性其乳腺癌相关的死亡风险会下降36%。

作者分析了2002至2005年间招募的2042名年龄介于50至74岁之间的德国乳腺癌患者的数据，并在2009年和2015年6月分别跟进了一次。在这2042名女性中，有1349名（66.1%）在确诊前至少进行过1次体力活动，有1253名（61.4%）在确诊后至少进行过一次体力活动。

Audrey Jung表示：“我们观察研究对象的时间（诊断后11.6年）是所有评估诊断前后休闲运动和疾病预后关系的类似研究中最长的。这使得我们能够考察体力活动及其变化对癌症预后（如总死亡率、乳腺癌相关死亡率和复发率）的长期影响。”

作者提醒，在第一次跟进时病人已经在诊断出乳腺癌后存活了大约6年，这将研究结果来源限制为乳腺癌的长期幸存者。为了更好地了解乳腺癌患者诊断前后的活动水平与生存率增加之间复杂的关系，需要进行大规模的随机对照试验。

作者表示，这些研究结果与其他研究相结合，表明运动对提高乳腺癌诊断后的生存率很重要，尤其应该鼓励在诊断前不太运动的女性病人进行体育锻炼。作者建议女性们遵守世界卫生组织建议的全球体力活动指南。

摘要：

Background

Physical activity (PA) before and after breast cancer diagnosis has been reported to be associated with lower mortality. However, whether changes in the activity after diagnosis impact prognosis is unclear and has not received much attention. This study aimed to examine pre- to postdiagnosis leisure-time PA and breast cancer prognosis.

Methods

We used data from the MARIE study, a prospective population-based patient cohort study of 3813 postmenopausal breast cancer patients, aged 50–74 at diagnosis, recruited from 2002 to 2005, re-interviewed in 2009, and followed up until June 2015. Prediagnosis PA was assessed at recruitment; postdiagnosis PA was assessed at re-interview in 2009. To examine pre- to postdiagnosis change in PA, women were categorized by pre- and postdiagnosis PA using a cut-off of 7.5 MET-h/week for meeting PA recommendations and combined into four groups: insufficiently active, increasingly active, decreasingly active, and sufficiently active. Cox regression models with delayed entry were used to assess associations between pre- to postdiagnosis patterns of PA and overall mortality (OM), breast cancer mortality (BCM), and recurrence-free survival (RFS). Additional analyses of pre- and postdiagnosis PA (no activity (reference), low activity, sufficient activity) with cancer outcomes, such as using a time-dependent model, were performed. In total, 2042 patients were included in the analyses.

Results

There were 206 deaths (114 from breast cancer) after a median follow-up time of 6.0 years after the 2009 interview. Compared to insufficiently active women, increasingly active women were at lower risk of OM, BCM, and RFS (HR (95%CI) of 0.50 (0.31–0.82), 0.54 (0.30–1.00), 0.58 (0.40–0.84), respectively). In sufficiently active women, associations for OM (0.75 (0.48–1.15)), BCM (0.61 (0.33–1.13)), and RFS 0.80 (0.57–1.14)) were similar to increasingly active women but attenuated, and decreasingly active women were not at lower risk for OM (0.91 (0.61–1.36)), BCM (0.80 (0.45–1.42)), and RFS (1.04 (0.76–1.43)). In time-dependent analyses, sufficient activity vs. no activity was associated with better OM (0.73 (0.57–0.93)), BCM (0.64 (0.46–0.89)), and RFS (0.82 (0.68–0.99)). Low activity was not significantly associated with prognosis.

Conclusion

Our data support benefits for breast cancer prognosis in being physically active pre- and postdiagnosis particularly for women who were insufficiently active prediagnosis.

（来源：科学网）