乳腺癌患者体力活动对生存的影响

　　众所周知，体力活动可以减少女性的乳腺癌发生风险。不过，乳腺癌发生后，体力活动对乳腺癌患者死亡或复发风险的影响尚不明确。

　　2019年2月16日，欧洲乳腺癌专科医师学会《乳腺》在线发表希腊雅典大学、意大利米兰大学的研究报告，进一步量化了乳腺癌诊断后体力活动对全因死亡、乳腺癌死亡、乳腺癌复发的影响。

　　该系统回顾与荟萃分析对PubMed截至2017年11月发表的观察研究进行检索，对乳腺癌确诊女性总死亡、乳腺癌死亡、乳腺癌复发与任何类型体力活动的相关性进行分析。通过随机效应模型，推算最高与最低类别体力活动相比的汇总风险比和95%置信区间。

　　结果，检索筛选10项研究进行荟萃分析，平均随访3.5～12.7年，共计2万3041例乳腺癌存活，其中2522例死于任何原因、841例死于乳腺癌、1398例复发或恶化。

　　休闲体力活动水平最高与最低（五分之一或四分之一）的女性相比：

• 全因死亡风险低42%（风险比：0.58，95%置信区间：0.45～0.75；8项研究，异质性：52.4%）

• 乳癌死亡风险低40%（风险比：0.60，95%置信区间：0.36～0.99；5项研究，异质性：77.7%）

• 复发恶化风险低21%（风险比：0.79，95%置信区间：0.60～1.05；5项研究，异质性：66.4%）

　　因此，该研究结果表明，乳腺癌诊断后的休闲体力活动水平，与全因死亡率和乳腺癌风险率成反比，与复发率也成反比但不显著。该结果可能反映体力活动水平对心血管所致死亡、乳腺癌所致死亡的减少作用。当然，回顾观察研究（而非前瞻干预研究）也有可能存在反向因果关系：死亡减少可以增加体力活动水平，即长期未死患者才有可能增加体力活动水平。

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Breast. 2019 Feb 16;44:144-152. [Epub ahead of print]

Physical activity in breast cancer survivors: A systematic review and meta-analysis on overall and breast cancer survival.

Maria-Eleni Spei, Evangelia Samoli, Francesca Bravi, Carlo La Vecchia, Christina Bamia, Vassiliki Benetou.

National and Kapodistrian University of Athens, Athens, Greece; University of Milan, Milan, Italy.

HIGHLIGHTS

• Physical activity was associated with survival among breast cancer survivors.

• Post-diagnosis physical activity was inversely associated with all-cause mortality.

• Post-diagnosis physical activity was inversely associated with breast-cancer mortality.

• The inverse association with breast cancer recurrence was consistent but not significant.

AIM: To further quantify the association between physical activity (PA) after breast cancer diagnosis and all-cause mortality, breast cancer mortality and/or breast cancer recurrence.

METHODS AND RESULTS: PubMed was searched until November 2017 for observational studies investigating any type of PA in association with total mortality, breast cancer mortality and/or breast cancer recurrence among women with breast cancer diagnosis. Pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using random-effects models for highest versus lowest categories of PA. Ten studies were included in the meta-analysis. During an average follow-up ranging from 3.5 to 12.7 years there were 23,041 breast cancer survivors, 2,522 deaths from all causes, 841 deaths from breast cancer and 1,398 recurrences/remissions. Compared to women in the lowest recreational PA level (lowest quintile/quartile), women in the highest level had a lower risk of all-cause mortality (HR = 0.58, 95% CIs: 0.45-0.75; 8 studies), of death from breast cancer (HR = 0.60, 95% CIs 0.36-0.99; 5 studies) and a lower, albeit non-significant, risk of recurrence (HR = 0.79, 95% CIs 0.60-1.05; 5 studies). There was evidence of heterogeneity between the studies evaluating recreational PA and total mortality (Ι2 = 52.4%) and even higher for breast cancer mortality (Ι2 = 77.7%) or recurrence (Ι2 = 66.4%).

CONCLUSION: Highest recreational PA after breast cancer diagnosis was associated with lower all-cause and breast cancer mortality. This finding probably reflects the favorable impact of PA on cardiovascular mortality, and a possible favorable role on breast cancer survival, though reverse causation cannot be excluded.

KEYWORDS: Meta-analysis, Systematic review, Physical activity, Breast cancer, Survival, Breast cancer survivors

DOI: 10.1016/j.breast.2019.02.001