Unit of Upper Gastrointestinal Research, Department of Molecular Medicine and Surgery, Norra Stationsgatan 67, Level 2, Karolinska Institutet, 171 76 Stockholm, Sweden.
Nat Rev Clin Oncol. 2013 Sep;10(9):519-33. doi: 10.1038/nrclinonc.2013.120. Epub 2013 Jul 16.
A large body of epidemiological evidence links obesity to increased cancer incidence, with some studies also indicating poorer survival in obese patients with cancer. Obese patients face several specific challenges related to diagnosis and treatment of cancer. Reduced participation in cancer screening programmes, lower tumour-marker expression and issues with medical imaging among obese individuals complicate cancer diagnosis. Chemotherapy and hormonal therapy in obese patients with cancer is affected by altered pharmacokinetics and hormone levels. In addition, the precision of radiotherapy might be adversely affected in this population by greater skin motility and increased motion of internal organs. Obese patients also face higher risk of minor complications after surgery. There is a need for additional research addressing issues specifically associated with the clinical management of obese patients with cancer, including comorbidity, polypharmacy, and problems related to sarcopenia and health-related quality of life. This Review summarizes the available literature addressing the clinical management of obese patients with cancer and discusses opportunities to improve the cancer care of these patients.
大量的流行病学证据表明肥胖与癌症发病率的增加有关，一些研究还表明肥胖癌症患者的生存率较低。肥胖患者在癌症的诊断和治疗方面面临着一些特殊的挑战。肥胖者的癌症筛查参与率降低，肿瘤标志物的表达水平较低，医学影像学也存在问题，这些都使癌症的诊断变得复杂。肥胖癌症患者的化疗和激素治疗受到药代动力学和激素水平改变的影响。此外，由于皮肤活动度增加和内部器官运动增加，放射治疗的精确性也可能受到影响。肥胖患者在手术后也面临更高的轻微并发症风险。需要进行更多的研究，专门解决与肥胖癌症患者的临床管理相关的问题，包括合并症、多种药物治疗以及与肌肉减少症和与健康相关的生活质量相关的问题。这篇综述总结了目前关于肥胖癌症患者临床管理的文献，并讨论了改善这些患者癌症治疗的机会。
