Relationship Between Pre-diagnosis Physical Activity And Risk Of All-cause Mortality In Patients With Ovarian Cancer:A Prospective Cohort Study

Objective: The association between physical activity(PA)and ovarian cancer(OC)mortality was not clear.To date,no studies have systematically investigated the relationships between all types of PA(including Occupational PA,Leisure time PA,Transportation PA,Household PA and Total PA)and mortality among OC patients.The purpose of this study was to examine the relationships between different types of PA and OC all-cause mortality using the date from ovarian cancer follow-up study(OOPS),providing evidence for reducing mortality of ovarian cancer patients.Methods: In the present study,ovarian cancer patients aged 18-75 admitted to Shengjing Hospital of China Medical University from 2015 to 2020 were enrolled.Information on general demographic characteristics,reproductive history,dietary history,and physical activity was collected through a structured questionnaire.Physical activity was assessed at recruitment via a validated PA questionnaire,the Physical Activity Scale of the China Prospective Study of Chronic Diseases project.Metabolic equivalents of task(MET)score were calculated for different types of activities,based on the 2011 Compendium of Physical Activities.The number of deaths was determined through medical records and active follow-up until 31 March 2021.Nonparametric tests and Chi-square test were used to compare the differences in baseline characteristics among OC patients with different levels of PA.Multivariate Cox proportional hazard regression model was used to explore the associations between Total PA,Occupational PA,Nonoccupational PA,Leisure time PA,Transportation PA,Household PA and all-cause mortality of OC patients.Subgroup analyses were performed according to age at diagnosis,BMI,menopausal status,residual lesions,histological type,FIGO(International Federation of Gynecology and Obstetrics)stage and Immunohistochemistry indicators and further analyze the interactions.Results: Until 31 March 2021,a total of 130 women were died.After adjusting for potential confounding factors,there was no significant association between Total PA,Occupational PA,Nonoccupational PA,Leisure time PA,Transportation PA,Household PA and all-cause mortality of OC.Subgroup analyses showed that Total PA was associated with reduced mortality among premenopausal OC patients,Hazard ratio(HR)and 95%Confidence interval(95% CI)were 0.31(0.10,0.96).Occupational PA was associated with reduced mortality among premenopausal patients,HR(95% CI)were 0.35(0.14,0.90).Leisure time PA was associated with reduced mortality in OC patients with residual lesions and positive expression of WT-1,HR(95% CI)were 0.33(0.13,0.81),0.48(0.24,0.98).Higher Transportation PA was associated with increased mortality in patients with nonserous histological type and negative expression of WT-1,HR(95% CI)were(3.44(1.13,10.41),5.26(1.72,16.05).Furthermore,there were multiplicative interactions between Total PA and the expression of ER and WT-1(P<0.05),and additive interactions between total PA and BMI,menopausal status and histological type(RERI = 0.41(0.11,0.72),0.48(0.09,0.86),0.57(0.15,0.99)).Multiplicative interactions between Occupational PA and expression of ER and WT-1(P<0.05),and an additive interaction between Occupational PA and menopausal status(RERI = 0.58(0.29,0.87))were detected.Multiplicative interactions between Non-occupational PA and expression of PR,ER and WT-1(P<0.05)were detected.Multiplicative interactions between Transportation PA and histological type,expression of ER and WT-1(P<0.05),and an additive interaction between Transportation PA and histological type(RERI = 0.66(0.32,1.01)were detected.Multiplicative interactions between Household PA and age at diagnosis,BMI,FIGO stage,expression of PR,ER and WT-1(P<0.05),and an additive interaction between Household PA and residual lesions(RERI = 0.63(0.33,0.92))were detected.Conclusion: There may be no association between pre-diagnostic Total PA,Occupational PA,Nonoccupational PA,Leisure time PA,Transportation PA,Household PA and all-cause mortality in patients with OC,but the results of this study need to be further confirmed.