A Pan-Cancer Target Trial Emulation of Exercise and Distant Disease-Free Recurrence

Area of Science:

• Oncology
• Exercise Science
• Epidemiology

Background:

• Observational data was used to evaluate exercise's impact on distant disease-free survival (DDFS) in a pan-cancer cohort.
• A target trial emulation (TTE) framework was employed to mimic a randomized controlled trial (RCT).

Purpose of the Study:

• To assess the association between regular exercise and distant disease-free survival (DDFS) and overall survival (OS) in a diverse cancer patient population.
• To emulate an RCT using existing observational data to provide robust evidence on exercise interventions in oncology.

Main Methods:

• Patients were classified based on exercise levels at two time points (Th and T0), with an "exercise group" (≥10 MET-h/week at T0) and a "control group" (≤10 MET-h/week at T0).
• Kaplan-Meier methods and Cox proportional hazards models were utilized to estimate hazard ratios (HRs) for DDFS and OS.

Main Results:

• The study included 3,022 patients in the exercise group and 1,183 in the control group.
• After a median follow-up of 5.2 years, 5-year DDFS was 95% in the exercise group versus 92% in the control group.
• The adjusted HR for DDFS was 0.80 (95% CI, 0.59-1.09) and for OS was 0.78 (95% CI, 0.55-1.11) for the exercise group compared to the control group.

Conclusions:

• The TTE estimated a potential 20-30% improvement in DDFS for the exercise group compared to the control group.
• Findings support the further development of exercise as a therapeutic strategy in primary solid tumors.