title: Exercise and Prognosis on the Basis of Clinicopathologic and Molecular Features in Early-Stage Breast Cancer: The LACE and Pathways Studies.
abstract: To investigate whether the impact of postdiagnosis exercise on breast cancer outcomes in women diagnosed with early-stage breast cancer differs on the basis of tumor clinicopathologic and molecular features. Using a prospective design, 6,211 patients with early-stage breast cancer from two large population-based cohort studies were studied. Age-adjusted and multivariable Cox regression models were performed to determine the relationship between exercise exposure (total MET-hours/week) and recurrence and breast cancer-related death for: (i) all patients ("unselected" cohort), and on the basis of (ii) classic clinicopathologic features, (iii) clinical subtypes, (iv) PAM50-based molecular intrinsic subtypes, and (v) individual PAM50 target genes. After a median follow-up of 7.2 years, in the unselected cohort (n = 6,211) increasing exercise exposure was not associated with a reduction in the risk of recurrence (adjusted Ptrend = 0.60) or breast cancer-related death (adjusted Ptrend = 0.39). On the basis of clinicopathologic features, an exercise-associated reduction in breast cancer-related death was apparent for tumors <2 cm [HR, 0.50; 95% confidence interval (CI), 0.34-0.72], well/moderately differentiated tumors (HR, 0.63; 95% CI, 0.43-0.91), and ER-positive tumors (HR, 0.72; 95% CI, 0.53-0.97). Stratification by clinical subtype indicated that the ER(+)/PR(+)/HER2(-)/low-grade clinical subtype was preferentially responsive to exercise (recurrence: adjusted HR, 0.63; 95% CI, 0.45-0.88; breast cancer-related death: adjusted HR, 0.57; 95% CI, 0.37-0.86). The impact of exercise on cancer outcomes appears to differ as a function of pathologic and molecular features in early-stage breast cancer. Cancer Res; 76(18); 5415-22. ©2016 AACR.
authors.affiliation: Memorial Sloan Kettering Cancer Center, New York, New York. jonesl3@mskcc.org.
authors.forename: Lee W
authors.initials: LW
authors.lastname: Jones
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, California.
authors.forename: Marilyn L
authors.initials: ML
authors.lastname: Kwan
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, California.
authors.forename: Erin
authors.initials: E
authors.lastname: Weltzien
authors.affiliation: Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Sarat
authors.initials: S
authors.lastname: Chandarlapaty
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, California.
authors.forename: Barbara
authors.initials: B
authors.lastname: Sternfeld
authors.affiliation: Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah. Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah.
authors.forename: Carol
authors.initials: C
authors.lastname: Sweeney
authors.affiliation: Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah. The Associated Regional and University Pathologist Institute for Clinical and Experimental Pathology, Salt Lake City, Utah.
authors.forename: Philip S
authors.initials: PS
authors.lastname: Bernard
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, California.
authors.forename: Adrienne
authors.initials: A
authors.lastname: Castillo
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, California.
authors.forename: Laurel A
authors.initials: LA
authors.lastname: Habel
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, California.
authors.forename: Candyce H
authors.initials: CH
authors.lastname: Kroenke
authors.affiliation: Department of Preventive Medicine, University of Southern California, Los Angeles, California.
authors.forename: Bryan M
authors.initials: BM
authors.lastname: Langholz
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, California.
authors.forename: Charles P
authors.initials: CP
authors.lastname: Queensberry
authors.affiliation: Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Chau
authors.initials: C
authors.lastname: Dang
authors.affiliation: Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Britta
authors.initials: B
authors.lastname: Weigelt
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, California.
authors.forename: Lawrence H
authors.initials: LH
authors.lastname: Kushi
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, California.
authors.forename: Bette J
authors.initials: BJ
authors.lastname: Caan
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000235:genetics / Q000401:mortality / Q000473:pathology*; D015331:Cohort Studies; D015444:Exercise / Q000502:physiology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D011379:Prognosis; D016016:Proportional Hazards Models