Modesitt Susan C, van Nagell John R
Gynecologic Oncology Division, Department of Obstetrics and Gynecology, University of Kentucky Chandler Medical Center, Lucille Markey Cancer Center, 800 Rose Street, Lexington, KY 40536-0298, USA.
Obstet Gynecol Surv. 2005 Oct;60(10):683-92. doi: 10.1097/01.ogx.0000180866.62409.01.
Sixty-five percent of the adult population in the United States is overweight and 30% of the population is obese. There is mounting evidence that obesity is a risk factor for gynecologic cancers and may also adversely impact survival. The objectives of this review were to systematically evaluate and discuss the impact of overweight and obesity on endometrial, ovarian, and cervical cancer incidence and to review the data on the impact of obesity on treatment of these same gynecologic cancers. A PUBMED literature search was performed to identify articles in the English language that focused on the impact of obesity on cancer incidence and treatment. References of identified articles were also used to find additional related articles. Obesity profoundly increases the incidence of endometrial cancer, predominantly through the effects of unopposed estrogen. Although the data are less compelling in ovarian and cervical cancer, obesity may modestly increase the incidence of premenopausal ovarian cancer and might potentially increase cervical cancer incidence, perhaps as a result of the impact on glandular cancers or decreased screening compliance. Obese women with cancer have decreased survival; this may be disease-specific, the result of comorbid illnesses, or response to treatment. Obese women have increased surgical complications, may also have increased radiation complications, and there is no current consensus regarding appropriate chemotherapy dosing in the obese patient. Obesity is a serious health problem with significant effects on the incidence and treatment of the gynecologic malignancies.
Obstetricians & Gynecologists, Family Physicians.
After completion of this article, the reader should be able to summarize the clear evidence that obesity is a risk factor for many cancers, including gynecologic malignancies; describe the role of unopposed estrogen in gynecologic cancers; and explain that obese women overall have a poorer survival rate when afflicted with cancer.
美国65%的成年人口超重，30%的人口肥胖。越来越多的证据表明，肥胖是妇科癌症的一个危险因素，也可能对生存率产生不利影响。本综述的目的是系统评估和讨论超重和肥胖对子宫内膜癌、卵巢癌和宫颈癌发病率的影响，并回顾肥胖对这些妇科癌症治疗影响的数据。进行了一项PubMed文献检索，以识别关注肥胖对癌症发病率和治疗影响的英文文章。已识别文章的参考文献也用于查找其他相关文章。肥胖显著增加子宫内膜癌的发病率，主要是通过无对抗雌激素的作用。尽管在卵巢癌和宫颈癌方面的数据不那么有说服力，但肥胖可能会适度增加绝经前卵巢癌的发病率，并可能增加宫颈癌的发病率，这可能是由于对腺癌的影响或筛查依从性降低所致。患有癌症的肥胖女性生存率降低；这可能是疾病特异性的，是合并症的结果，或对治疗的反应。肥胖女性手术并发症增加，放疗并发症也可能增加，目前对于肥胖患者合适的化疗剂量尚无共识。肥胖是一个严重的健康问题，对妇科恶性肿瘤的发病率和治疗有重大影响。
产科医生和妇科医生、家庭医生。
阅读本文后，读者应能够总结肥胖是包括妇科恶性肿瘤在内的许多癌症的危险因素这一明确证据；描述无对抗雌激素在妇科癌症中的作用；并解释肥胖女性患癌症时总体生存率较低。
