Background: Prehabilitation is increasingly being used in patients undergoing multimodality treatment for oesophagogastric cancer (OGC). Most studies to date have been small, single-centre trials. This collaborative study sought to assess the overall impact of prehabilitation on patient outcomes following OGC surgery. Methods: Data came from four prospective prehabilitation trials conducted in the UK or Ireland in patients undergoing multimodality treatment for OGC. The studies included three randomised and one non-randomised clinical trial, each comparing a prehabilitation intervention group to controls. The prehabilitation interventions included aerobic training delivered by exercise physiologists alongside dietetic input throughout the treatment pathway. The primary outcome was survival (all-cause and disease-specific mortality). Secondary outcomes were differences in complications, cardio-respiratory fitness (changes in VO2 peakand anaerobic threshold (AT)), chemotherapy completion rates, hospital length of stay, changes in body mass index, tumour regression and complication rates of anastomotic leak and pneumonia. Cox and logistic regression analysis provided hazard ratios (HR) and odds ratios (OR), respectively, with 95% confidence intervals (CI), adjusted for confounders. Results: Among 165 patients included, 88 patients were in the prehabilitation group and 77 patients were in the control group. All-cause and disease-specific mortality were not improved by prehabilitation (HR 0.67 95% CI 0.21–2.12 and HR 0.82 95% CI 0.42–1.57, respectively). The prehabilitation group experienced fewer major complications (20% vs. 36%,p= 0.034; adjusted OR of 0.54; 95%CI 0.26–1.13). There was a mitigated decline in VO2 peakfollowing neo-adjuvant therapy (delta prehabilitation −1.07 mL/kg/min vs. control −2.74 mL/kg/min;p= 0.035) and chemotherapy completion rates were significantly higher following prehabilitation (90% vs. 73%;p= 0.016). Hospital length of stay (10 vs. 12 days,p= 0.402) and neoadjuvant chemotherapy response (Mandard 1–3 41% vs. 35%;p= 0.494) favoured prehabilitation, albeit not statistically significantly. Conclusion: Despite some limitations in terms of heterogeneity of study methodology, this study suggests a number of meaningful clinical benefits from prehabilitation before surgery for OGC patients. Current initiatives to agree on national standards for delivering prehabilitation and the results of ongoing trials will help to further refine this important intervention and expand the evidence base to support the widespread adoption and implementation of prehabilitation programs.
背景：预康复在食管胃结合部癌（OGC）多模式治疗患者中的应用日益广泛。目前大多数研究为小规模单中心试验。本协作研究旨在评估预康复对OGC术后患者结局的总体影响。 方法：数据来源于英国或爱尔兰开展的四项针对接受多模式治疗的OGC患者的前瞻性预康复试验。这些研究包括三项随机临床试验和一项非随机临床试验，均将预康复干预组与对照组进行比较。预康复干预措施包括由运动生理学家提供的有氧训练，并在整个治疗过程中辅以营养支持。主要结局指标为生存率（全因死亡率和疾病特异性死亡率）。次要结局指标包括并发症差异、心肺适能（峰值摄氧量和无氧阈的变化）、化疗完成率、住院时间、体重指数变化、肿瘤退缩情况以及吻合口漏和肺炎的并发症发生率。采用Cox回归和逻辑回归分析分别计算风险比（HR）和比值比（OR），并调整混杂因素后给出95%置信区间（CI）。 结果：在纳入的165例患者中，预康复组88例，对照组77例。预康复未能改善全因死亡率（HR 0.67，95% CI 0.21–2.12）和疾病特异性死亡率（HR 0.82，95% CI 0.42–1.57）。预康复组严重并发症发生率较低（20% vs. 36%，p=0.034；调整后OR 0.54，95% CI 0.26–1.13）。新辅助治疗后峰值摄氧量下降幅度较小（预康复组变化值-1.07 mL/kg/min vs. 对照组-2.74 mL/kg/min，p=0.035），且预康复后化疗完成率显著更高（90% vs. 73%，p=0.016）。住院时间（10天 vs. 12天，p=0.402）和新辅助化疗反应（Mandard 1–3级 41% vs. 35%，p=0.494）虽未达到统计学显著性，但均显示预康复组更优。 结论：尽管研究方法存在异质性等局限，本研究提示预康复能为OGC患者术前带来多项具有临床意义的获益。当前制定国家预康复实施标准的倡议以及正在进行的试验结果，将有助于进一步完善这一重要干预措施，并为预康复项目的广泛推广和实施提供更充分的证据支持。
肿瘤(癌症)患者之家