Pre-diagnostic physical activity and mortality in cervical cancer: a nationwide cohort study
The prognostic significance of pre-diagnostic physical activity in cervical cancer remains unclear. This study examined the association between pre-diagnostic physical activity and all-cause mortality among women with cervical cancer. In a population-based cohort study using nationwide South Korean registry data, 8833 women aged 19 to 79 years with newly diagnosed cervical cancer who completed health screenings within 1 year before diagnosis were analyzed. Physical activity was self-reported and categorized by intensity, duration, and total energy expenditure in metabolic equivalent task-minutes per week. All-cause mortality was assessed using multi-variable Cox proportional hazards models with sub-group analyses by Surveillance, Epidemiology, and End Results stage and age. Among the study population, 64.9% had localized, 23.7% regional, and 5.0% distant disease. Higher total energy expenditure was associated with reduced mortality. Compared with <500 metabolic equivalent task-minutes per week, 500 to 1499 metabolic equivalent task-minutes per week was associated with lower mortality (hazard ratio [HR] 0.87, 95% confidence interval [CI] 0.77 to 0.98). Physical activity intensity alone was not independently associated with mortality; however, among patients with localized disease, vigorous-intensity activity (HR 0.64, 95% CI 0.43 to 0.95) and regular exercise (HR 0.62, 95% CI 0.43 to 0.88) were associated with lower mortality. Among patients aged ≥65 years, associations between physical activity and mortality were observed mainly in localized-stage disease, with no significant associations in other stages or younger age groups. Higher levels of pre-diagnostic physical activity were associated with improved survival in women with localized cervical cancer, particularly among those aged ≥65 years. These findings suggest that pre-diagnostic physical activity may have prognostic relevance in specific patient sub-groups.