运动作为抗癌药物？肿瘤学中的证据、机制与实施。
完整摘要 · 中文译文
过去二十年的研究已将运动从一般性生活方式的建议重新定位为一种潜在的抗癌干预手段。对超过140万参与者的汇总分析将规律体力活动与至少13种肿瘤类型的较低发病率联系起来，前瞻性队列数据报告在最活跃的乳腺癌、结直肠癌、前列腺癌和肺癌患者中，癌症特异性死亡率降低24%–31%，尽管这些估计来自采用自我报告活动量的观察性设计。2025年，一项针对III期结肠癌的III期试验提供了第一项随机证据，表明结构化的运动和行为改变计划可在辅助化疗后改善无病生存期和总生存期；随后一项卵巢癌随机试验未显示无进展生存期获益。候选机制包括胰岛素和生长因子信号传导、肌因子分泌、免疫动员、慢性炎症减轻以及肠道微生物组重塑，尽管这些所依据的证据范围从细胞培养到人体试验不等，且很少按证据等级加以区分。尽管有这些证据，结构性、教育性和经济性障碍仍阻碍着将运动纳入常规肿瘤诊疗。本综述综合现有证据，并确定临床采纳所需的步骤。
完整摘要 · 英文原文
Research over the past two decades has repositioned exercise from a general lifestyle recommendation to a potential anticancer intervention. Pooled analyses of more than 1.4 million participants link regular physical activity with lower incidence of at least 13 tumour types, and prospective cohort data report cancer-specific mortality 24-31% lower among the most active patients with breast, colorectal, prostate and lung cancer, although these estimates derive from observational designs using self-reported activity. In 2025, a phase III trial in stage III colon cancer provided the first randomised evidence that a structured exercise and behaviour-change programme improves disease-free and overall survival after adjuvant chemotherapy; a randomised trial in ovarian cancer subsequently did not show a progression-free survival benefit. Candidate mechanisms include insulin and growth-factor signalling, myokine secretion, immune mobilisation, reduced chronic inflammation and gut microbiome remodelling, although these rest on evidence ranging from cell culture to human trials and are rarely distinguished by level. Despite this evidence, structural, educational and economic barriers prevent integration of exercise into routine oncology care. This Review synthesises the available evidence and identifies the steps required for clinical adoption.