Webb Penelope M
From the Queensland Institute of Medical Research, Brisbane, Australia.
Am Soc Clin Oncol Educ Book. 2013. doi: 10.1200/EdBook_AM.2013.33.e222.
The prevalence of overweight and obesity in the United States and elsewhere has increased dramatically in recent decades. It has long been known that obese women have an increased risk of developing endometrial cancer, but recent studies suggest this association is strongest for the most common low-grade endometrioid endometrial cancers and weaker for the other histologic subtypes. There are insufficient data to assess whether obesity affects endometrial cancer-specific survival or whether the relation with all-cause mortality is similar to that seen in the general population. Recent data suggest obesity also increases risk of ovarian cancer, although it may not influence risk of the high-grade serous cancers that account for the majority of ovarian cancer deaths, and that it is also associated with poorer outcomes. There is currently insufficient evidence to draw any clear conclusions regarding the relation between obesity and risk of/survival from other gynecologic cancers although there are suggestions that obesity may increase risk of cervical cancer, particularly adenocarcinoma, and perhaps vulvar cancer. Possible mechanisms whereby obesity might influence gynecologic cancer risk and survival include: its strong association with endogenous estrogen levels among postmenopausal women, its effects on glucose metabolism, its effects on the wide range of adipocytokines and inflammatory mediators that are produced by adipose tissue and altered in concentration among obese individuals, and its potential effects on patient management, particularly with regard to chemotherapy dosing.
近几十年来，美国及其他地区超重和肥胖的患病率急剧上升。长期以来，人们都知道肥胖女性患子宫内膜癌的风险增加，但最近的研究表明，这种关联在最常见的低级别子宫内膜样腺癌中最为明显，而在其他组织学亚型中则较弱。目前尚无足够数据评估肥胖是否会影响子宫内膜癌特异性生存率，或者其与全因死亡率的关系是否与普通人群相似。最近的数据表明，肥胖也会增加卵巢癌风险，尽管它可能不会影响占卵巢癌死亡大多数的高级别浆液性癌的风险，而且肥胖还与较差的预后相关。目前没有足够的证据就肥胖与其他妇科癌症风险/生存率之间的关系得出任何明确结论，尽管有迹象表明肥胖可能会增加宫颈癌，尤其是腺癌，以及可能的外阴癌的风险。肥胖可能影响妇科癌症风险和生存率的潜在机制包括：它与绝经后女性内源性雌激素水平密切相关，对葡萄糖代谢的影响，对脂肪组织产生且在肥胖个体中浓度改变的多种脂肪细胞因子和炎症介质的影响，以及对患者管理的潜在影响，特别是在化疗剂量方面。
