肥胖对肿瘤患者治疗和临床结局的影响

Impact of obesity on therapy response and clinical outcomes in cancer patients

世界卫生组织对肥胖的定义为BMI≥30;由于东方人体型较小缘故,我国对肥胖界定为BMI≥28。我国是肥胖大国,2014年我国肥胖人口数已近9,000万人。大量研究表明,肥胖与肿瘤发病有着密不可分的关系,目前已被证实与肥胖相关的肿瘤为13种左右。因此,对于肥胖人群的体重管理,保证BMI处于正常范围内仍是规避肿瘤发病风险的重要手段。同时肥胖也影响着肿瘤患者的治疗效果及远期生存,多篇研究表明,肥胖可能对肿瘤治疗过程中的各个环节产生影响。而随着肥胖及肿瘤发病率的双升高,临床中肥胖肿瘤患者的治疗也越来越成为临床工作者需要考量的问题。长期以来,肥胖被视作肿瘤治疗的“绊脚石”,然而近年来一些研究提出肥胖在手术、化疗、靶向、免疫治疗疗效中的双重作用即“肥胖悖论”:相较于BMI处于正常范围的患者,超重和轻度肥胖肿瘤患者获得最好生存收益以及疗效,而中重度肥胖及体重过轻均可造成较差预后。这使得研究者认识到肥胖影响肿瘤治疗的另一面。因此,肥胖肿瘤患者的体重管理方案、治疗策略、远期生存预测,均需通过进一步的临床前研究以及临床实践不断摸索与建立,而更为细致、深入的了解肥胖与肿瘤的关系,将为肿瘤的防治提供更有力的依据及思路。本文主要就肥胖对肿瘤治疗影响及其进展作一综述。

The world health organization defines obesity as a body mass index(BMI)of no less than 30.Because of the small size of the oriental human body,obesity is defined as BMI≥28 in China.There is a large amount of obesity patient in our country,which is nearly 90 million in 2014.Many researches showed that obesity is associated closely with the incidence of tumors.Currently,there are about 13 types of obesity-related tumors.Therefore,ensuring that BMI is within the normal range is still a correct choice for avoiding the risk of cancer.At the same time,obesity also affects the therapy response and long-term survival of cancer patients.Many studies have shown that obesity may have an effect during the whole process of tumor treatment.With the increasing incidence of obesity and tumor,the treatment for obese cancer patients in clinical practice has become an issue which clinicians need to consider.For a long time,obesity has been regarded as a stumbling block in cancer treatment.However,in recent years,some studies have identified the dual role of obesity in the efficacy of surgery,chemotherapy,targeting therapy,and immunotherapy,in other words,“obesity paradox”:overweight and mildly obese cancer patients have the better survival benefit and response to therapy,while moderate to severe obesity and underweight are related to poor prognosis.Researchers now recognize that obesity may affect the cancer treatment in another way.Therefore,the weight management,treatment strategy,and long-term survival prediction of obese tumor patients need to be explored and established through further pre-clinical research and clinical practice,and a more detailed and in-depth understanding of the relationship between obesity and tumor will be warrant for prevention and treatment of cancer.This article reviews the effects and advanced progress of obesity on cancer treatment.