肥胖对癌症疗法有效性和结果的多因素影响
The multifactorial effect of obesity on the effectiveness and outcomes of cancer therapies
影响因子:40.00000
分区:医学1区 Top / 内分泌学与代谢1区
发表日期:2024 Dec
作者:
Joanne Lysaght, Melissa J Conroy
摘要
流行病学研究表明，肥胖症与几种不同的恶性肿瘤的发展之间存在明显的关联，并且内脏肥胖过度是癌症患者的治疗干预患者的越来越普遍的特征。临床试验和荟萃分析有助于为成年癌症和肥胖症患者的传统系统施用抗癌药的有效和安全剂量提供信息，但是关于肥胖对肥胖对更新颖的靶向分子和免疫疗法的影响的争议仍然太多，而且最佳地定义了肥胖症的方式和测量。低肌肉质量与癌症的结果不佳有关，并且使用生化和成像方式的身体组成研究有助于充分描述肥胖和肌肉减少症在临床结果中的重要性。这样的研究也可能会某种方式解释肥胖如何与某些癌症中有利的临床结局矛盾。随着癌症生存期的增加，抗癌治疗的持续时间延长，这篇评论突出了适当的治疗选择面临的挑战，并强调了如何有必要在癌症治疗期间和之后如何管理多学科的方法来管理体重和骨骼肌损失。
Abstract
Epidemiology studies have demonstrated a clear association between obesity and the development of several distinct malignancies, with excessive visceral adiposity being an increasingly prevalent feature in patients with cancer presenting for therapeutic intervention. Clinical trials and meta-analyses have helped to inform effective and safe dosing of traditional systemically administered anticancer agents in adult patients with cancer and obesity, but there remains much debate not only regarding the effect of obesity on the more novel targeted molecular and immune-based therapies, but also about how obesity is best defined and measured clinically. Low muscle mass is associated with poor outcomes in cancer, and body composition studies using biochemical and imaging modalities are helping to fully delineate the importance of both obesity and sarcopenia in clinical outcomes; such studies might also go some way to explaining how obesity can paradoxically be associated with favourable clinical outcomes in certain cancers. As the cancer survivorship period increases and the duration of anticancer treatment lengthens, this Review highlights the challenges facing appropriate treatment selection and emphasizes how a multidisciplinary approach is warranted to manage weight and skeletal muscle loss during and after cancer treatment.