癌症患者临床上重要的体重减轻的现有定义并未具体解决就诊时肥胖患者的体重减轻。本综述探讨了肥胖患者体重减轻和骨骼肌质量消耗（即定义癌症恶病质的标准）的临床影响。许多最近的研究表明，超重和肥胖的 BMI 值对癌症患者具有生存优势与正常和体重不足范围内的 BMI 相比，处于晚期阶段。癌症相关体重减轻的分类已经演变，当前的分级方案评估体重在 BMI 值范围内的影响。 BMI 超过 30kg/m2 的患者体重减轻与死亡率相关，但与 BMI 值较低的患者相比，体重减轻的程度要轻得多。诊断成像可以精确评估癌症患者的骨骼肌指数（SMI），并且已经清楚地表明，虽然通常肌肉发达，但肥胖患者可能会出现严重的肌肉耗竭（即肌肉减少症），而与是否存在体重减轻无关。肌肉损耗与肥胖患者的死亡率以及癌症手术和全身治疗的并发症密切相关。诊断并发肥胖和恶病质似乎是矛盾的，因为这些术语代表了体重谱的两端。任何患有癌症的人都可能发生体重减轻，但与低体重个体相比，肥胖个体的临床管理优先级可能较低。少肌性肥胖与不良临床结果密切相关，值得进一步研究、临床实践诊断以及新的缓解策略。版权所有 © 2024 Wolters Kluwer Health, Inc. 保留所有权利。

Existing definitions of clinically important weight loss in patients with cancer do not specifically address weight loss in patients who are obese at presentation. This review explores the clinical impact of weight loss and depletion of the skeletal muscle mass (i.e., criteria defining cancer cachexia), in patients with obesity.Overweight and obese BMI values are shown by many recent studies to pose a survival advantage in patients with cancers of advanced stage, when compared with BMI in normal and underweight ranges. The classification of cancer-associated weight loss has evolved, and current grading schemes evaluate the impact of weight across the range of BMI values. Weight loss is associated with mortality in patients with BMI more than 30 kg/m2, however this is to a much lesser degree than in patients with lower BMI values. Diagnostic imaging permits the precise assessment of skeletal muscle index (SMI) in patients with cancer, and it has been clearly shown that while usually quite muscular, obese patients can have profound muscle depletion (i.e., sarcopenia), independent of the presence of weight loss. Muscle depletion associates strongly with mortality in obese patients, as well as with complications of cancer surgery and systemic therapy.It would seem contradictory to diagnose concurrent obesity and cachexia, as these terms represent opposite ends of the weight spectrum. Weight loss can occur in anyone with cancer, however its priority for clinical management may be lesser in obese versus low body weight individuals. Sarcopenic obesity is strongly associated with a poor clinical outcome and deserves further research, diagnosis in clinical practice, and new strategies for mitigation.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.