肥胖的多因素影响：对癌症治疗效果与结局的影响
The multifactorial effect of obesity on the effectiveness and outcomes of cancer therapies
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影响因子:40
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
DOI:
10.1038/s41574-024-01032-5
摘要
流行病学研究明确显示，肥胖与多种不同类型恶性肿瘤的发生密切相关，且内脏脂肪过多在求医治疗的癌症患者中逐渐普遍。临床试验和荟萃分析帮助优化了成人癌症患者中传统系统性抗癌药物的剂量，但对肥胖对新型靶向分子及免疫疗法的影响以及如何在临床上准确界定和测量肥胖仍存在争议。肌肉质量低与癌症预后不良有关，利用生物化学和影像学方法的身体组成研究正在帮助全面理解肥胖和肌少症在临床结局中的作用；这些研究或许还能部分解释为何在某些癌症中，肥胖反而与较佳的临床结局相关。随着癌症生存期延长和抗癌治疗时间增加，本文强调了在治疗选择中的挑战，强调多学科合作在治疗过程中管理体重和骨骼肌丢失的重要性。
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.