Division of Urologic Surgery and Duke Prostate Center, Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA.
Urol Oncol. 2011 Sep-Oct;29(5):476-86. doi: 10.1016/j.urolonc.2009.12.011. Epub 2010 Dec 13.
Obesity is a growing epidemic in the United States. Many genitourinary malignancies are ranked among the current leading causes of cancer. As a result, there has been a surge of interest in understanding the impact of obesity on genitourinary malignancies. We sought to review the current literature concerning the influence of obesity on prostate, kidney, and bladder cancer.
A PubMed search was performed using key words related to incidence, treatment, obesity, prostate, kidney, and bladder cancer. Relevant articles and their references were reviewed and utilized.
Obesity appears to promote an increased risk of aggressive prostate cancer (CaP). This may be related, in part, to a detection bias found in obese men. Worse surgical and radiation treatment outcomes in the obese appear to be related not only to technical challenges, but also inherent tumor biology differences and more aggressive disease presentations. A strong association between obesity and increased risk of renal cell carcinoma (RCC) has been established. Laparoscopic radical nephrectomy is now felt to be feasible in the obese and may be a lower morbidity technique compared with open surgery. Interestingly, obesity may confer an improved tumor-specific survival for localized RCC post nephrectomy. The influence of body mass index (BMI) on bladder cancer is poorly understood. Although a relationship may exist, due to the mixed and minimal observations, no firm conclusions should be drawn. Greater perioperative risks following open cystectomy have been found to occur in obese patients secondary to increase technical challenges.
The relationship between obesity and genitourinary malignancy is impressive. Technical challenges undoubtedly play a role in influencing treatment outcomes. Inherent biological effects are also likely influential. Future research is necessary to delineate these mechanisms and further clarify the influence of obesity on genitourinary cancer.
肥胖在美国是一种日益严重的流行疾病。许多泌尿生殖系统恶性肿瘤目前是癌症的主要致病原因之一。因此，人们对肥胖对泌尿生殖系统恶性肿瘤的影响产生了浓厚的兴趣。我们旨在回顾目前关于肥胖对前列腺癌、肾癌和膀胱癌影响的文献。
使用与发病率、治疗、肥胖、前列腺、肾脏和膀胱癌相关的关键词，在 PubMed 上进行了搜索。回顾并利用了相关文章及其参考文献。
肥胖似乎会增加侵袭性前列腺癌（CaP）的风险。这可能部分与肥胖男性中存在的检测偏差有关。肥胖患者手术和放疗效果较差，不仅与技术挑战有关，还与肿瘤固有生物学差异和更具侵袭性的疾病表现有关。肥胖与肾细胞癌（RCC）风险增加之间存在很强的关联。目前认为肥胖患者可行腹腔镜根治性肾切除术，与开放性手术相比，这种技术的发病率可能较低。有趣的是，肥胖可能会为接受肾切除术后的局限性 RCC 患者带来更好的肿瘤特异性生存。身体质量指数（BMI）对膀胱癌的影响知之甚少。尽管可能存在相关性，但由于观察结果混杂且较少，因此不应得出明确的结论。开放性膀胱切除术的肥胖患者围手术期风险更高，这主要是由于技术挑战增加所致。
肥胖与泌尿生殖系统恶性肿瘤之间存在显著关联。技术挑战无疑在影响治疗结果方面发挥了作用。固有生物学效应也可能具有影响力。需要进一步的研究来阐明这些机制，并进一步阐明肥胖对泌尿生殖系统癌症的影响。
