Abstract: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.
种晓艺, 张小田. 肥胖对肿瘤患者治疗和临床结局的影响[J]. 肿瘤代谢与营养电子杂志, 2019, 6(2): 172-177.
CHONG Xiao-yi, ZHANG Xiao-tian. Impact of obesity on therapy response and clinical outcomes in cancer patients. Electron J Metab Nutr Cancer, 2019, 6(2): 172-177.
1.Sung H, Siegel RL, Torre LA, et al. Global patterns in excess body weight and the associated cancer burden.CA Cancer J Clin. 2019;69(2):88-112.
2.Lauby-Secretan B, Scoccianti C, Loomis D, et al. Body fatness and cancer--viewpoint of the IARC working group. N Engl J Med. 2016;375(8):794-798.
3.中国超重/肥胖医学营养治疗专家共识编写委员会. 中国超重/肥胖医学营养治疗专家共识(2016年版).糖尿病临床. 2016;10(9):395-398.
4.Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19.2 million participants. Lancet. 2016;387(10026):1377-1396.
5.Cantrell LA, Zhou C, Mendivil A, et al. Metformin is a potent inhibitor of endometrial cancer cell proliferation: implications for a novel treatment strategy.Gynecol Oncol. 2010;116(1):92-98.
6.Kohda M, Hoshiya H, Katoh M, et al. Frequent loss of imprinting of IGF2 and MEST in lung adenocarcinoma. Mol Carcinog. 2001;31(4):184-191.
7.Giovannucci E, Harlan DM, Archer MC, et al. Diabetes and cancer: a consensus report. Diabetes Care. 2010;33(7):1674-1685.
8.Ramani K, Yang H, Xia M, et al. Leptins mitogenic effect in human liver cancer cells requires induction of both methionine adenosyltransferase 2A and 2 beta. Hepatology. 2008;47(2):521-531.
9.Neuwirth AK, Williams CJ, Barb D, et al. Adiponectin in relation to malignancies: a review of existing basic research and clinical evidence. Am J Clin Nutr. 2007;86(3):858S-866S.
10.Nakayama S, Miyoshi Y, Ishihara H, et al. Growth-inhibitory effect of adiponectin via adiponectin receptor 1 on human breast cancer cells through inhibition of S-phase entry without inducing apoptosis.Breast Cancer Res Treat.2008;112(3):405-410.
11.Mu N, Zhu YX, Wang YM, et al. Insulin resistance:a significant risk factor of endometrial cancer. Gynecol Oncol. 2012;125(3):751-757.
12.Clendenen TV, Koenig KL, Arslan AA, et al. Factors associated with inflammation markers, a cross-sectional analysis. Cytokine. 2011;56(3):769-778.
13.Zhang Y, Wang JP, Wang XL, et al. Computed tomography-quantified body composition predicts short-term outcomes after gastrectomy in gastric cancer. Curr Oncol. 2018;25(5):e411-e422.
14.Lee KH, Kang BK, Ahn BK. Higher visceral fat area/subcutaneous fat area ratio measured by computed tomography is associated with recurrence and poor survival in patients with mid and low rectal cancers. Int J Colorectal Dis. 2018;33(9):1303-1307.
15.Chen WZ, Chen XD, Ma LL, et al. Impact of visceral obesity and sarcopenia on short-term outcomes after colorectal cancer surgery. Dig Dis Sci. 2018;63(6):1620-1630.
16.Multicentre prospective cohort study of body mass index and postoperative complications following gastrointestinal surgery. Br J Surg. 2016;103(9):1157-1172.
17.Tulinsky L, Mittak M, Tomaskova H, et al. Obesity paradox in patients undergoing lung lobectomy - myth or reality? BMC Surg. 2018;18(1):61.
18.Gao H, Feng HM, Li B, et al. Impact of high body mass index on surgical outcomes and long-term survival among patients undergoing esophagectomy: A meta-analysis. Medicine (Baltimore). 2018;97(28):e11091.
19.Hughes TM, Shah K, Noria S, et al. Is BMI associated with post-operative complication risk among patients undergoing major abdominal surgery for cancer? A systematic review. J Surg Oncol. 2018;117(5):1009-1019.
20.Yasunaga H, Horiguchi H, Matsuda S, et al. Body mass index and outcomes following gastrointestinal cancer surgery in Japan. Br J Surg. 2013;100(10):1335-1343.
21.Griggs JJ, Mangu PB, Anderson H, et al. Appropriate chemotherapy dosing for obese adult patients with cancer: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol. 2012;30(13):1553-1561.
22.Stocker G, Hacker UT, Fiteni F, et al. Clinical consequences of chemotherapy dose reduction in obese patients with stage III colon cancer: A retrospective analysis from the PETACC 3 study. Eur J Cancer. 2018;99:49-57.
23.Morrison VA, Mccall L, Muss HB, et al. The impact of actual body weight-based chemotherapy dosing and body size on adverse events and outcome in older patients with breast cancer: Results from Cancer and Leukemia Group B (CALGB) trial 49907 (Alliance A151436). J Geriatr Oncol. 2018;9(3):228-234.
24.Bandera EV, Lee VS, Rodriguez-Rodriguez L, et al. Impact of chemotherapy dosing on ovarian cancer survival according to body mass index. JAMA Oncol. 2015;1(6):737-745.
25.Tran CG, Hill EE, Jensen B, et al. Survival benefit of obesity in stage IV colorectal cancer: Better tolerability of chemotherapy?J Clin Oncol. 2018;36(15):1.
26.Stevenson JKR, Qiao Y, Chan KKW, et al. Improved survival in overweight and obese patients with aggressive B-cell lymphoma treated with rituximab-containing chemotherapy for curative intent. Leuk Lymphoma. 2018;1-10.
27.Mentoor I, Engelbrecht AM, Van Jaarsveld PJ, et al. Chemoresis-tance: intricate interplay between breast tumor cells and adipocytes in the tumor microenvironment.Front Endocrinol (Lausanne). 2018;9:758.
28.Su F, Ahn S, Saha A, et al.Adipose stromal cell targeting suppresses prostate cancer epithelial-mesenchymal transition and chemoresistance. Oncogene. 2019;38(11):1979-1988.
29.Facundoa NaL, Romero LT, Castillejos CR, et al. Impact of obesity on survival and relapse prognosis in children with acute lymphoblastic leukaemia in Mexico State. Gaceta Mexicana De Oncologia. 2015;14(5):242-249.
30.Incio J, Liu H, Suboj P, et al. Obesity-induced inflammation and desmoplasia promote pancreatic cancer progression and resistance to chemotherapy. Cancer Discov. 2016;6(8):852-869.
31.Cortellini A, Palumbo P, Porzio G, et al. Single-institution study of correlations between skeletal muscle mass, its density, and clinical outcomes in non-small cell lung cancer patients treated with first-line chemotherapy. Thorac Cancer. 2018;9(12):1623-1630.
32.Kurita Y, Kobayashi N, Tokuhisa M, et al.Sarcopenia is a reliable prognostic factor in patients with advanced pancreatic cancer receiving FOLFIRINOX chemotherapy. Pancreatology.2019;19(1):127-135.
33.Van Baar H, Beijer S, Bours M J L, et al. Low radiographic muscle density is associated with lower overall and disease-free survival in early-stage colorectal cancer patients. J Cancer Res Clin Oncol. 2018;144(11):2139-2147.
34.Martel S, Poletto E, Ferreira AR, et al. Impact of body mass index on the clinical outcomes of patients with HER2-positive metastatic breast cancer. Breast. 2018;37:142-147.
35.Liu YL, Saraf A, Catanese B, et al. Obesity and survival in the neoadjuvant breast cancer setting: role of tumor subtype in an ethnically diverse population. Breast Cancer Res Treat. 2018;167(1):277-288.
36.Mcquade JL, Daniel CR, Hess KR, et al. Association of body-mass index and outcomes in patients with metastatic melanoma treated with targeted therapy, immunotherapy, or chemotherapy: a retrospective, multicohort analysis. Lancet Oncol. 2018;19(3):310-322.
37.Albiges L, Hakimi AA, Xie W, et al. Body mass index and metastatic renal cell carcinoma: clinical and biological correlations. J Clin Oncol. 2016;34(30):3655-3663.
38.Wang Z, Aguilar EG, Luna JI, et al. Paradoxical effects of obesity on T cell function during tumor progression and PD-1 checkpoint blockade. NAT MED. 2019(2019);25:141-151.
39.Lennon H, Sperrin M, Badrick E, et al. The obesity paradox in cancer: a review. Cur Oncol Rep. 2016;18(9):56.
40.Kroenke CH, Neugebauer R, Meyerhardt J, et al. Analysis of body mass index and mortality in patients with colorectal cancer using causal diagrams. JAMA Oncol. 2016;2(9):1137-1145.