Pazaitou-Panayiotou K, Polyzos S A, Mantzoros C S
Department of Endocrinology, Theagenion Cancer Hospital, Thessaloniki, Greece.
Obes Rev. 2013 Dec;14(12):1006-22. doi: 10.1111/obr.12070. Epub 2013 Aug 28.
The incidence of thyroid cancer has been rising over the past few decades along with a parallel increase in obesity. Observational studies have provided evidence for a potential association between the two. By contrast, clinical data for a link between type 2 diabetes mellitus, a condition strongly associated with obesity, and thyroid cancer are limited and largely not supportive of such an association. Obesity leads to hypoadiponectinemia, a pro-inflammatory state, and insulin resistance, which, in turn, leads to high circulating insulin and insulin-like growth factor-1 levels, thereby possibly increasing the risk for thyroid cancer. Thus, insulin resistance possibly plays a pivotal role in underlying the observed association between obesity and thyroid cancer, potentially leading to the development and/or progression of thyroid cancer, through its interconnections with other factors including insulin-like growth factor-1, adipocytokines/cytokines and thyroid-stimulating hormone. In this review, epidemiological and clinical evidence and potential mechanisms underlying the proposed association between obesity and thyroid cancer risk are reviewed. If the association between obesity and thyroid cancer demonstrated in observational studies proves to be causal, targeting obesity (and/or downstream mediators of risk) could be of importance in the prevention and management of thyroid cancer.
在过去几十年中，甲状腺癌的发病率一直在上升，与此同时肥胖率也在同步上升。观察性研究为两者之间的潜在关联提供了证据。相比之下，2型糖尿病（一种与肥胖密切相关的疾病）与甲状腺癌之间联系的临床数据有限，且大多不支持这种关联。肥胖会导致低脂联素血症、促炎状态和胰岛素抵抗，进而导致循环胰岛素和胰岛素样生长因子-1水平升高，从而可能增加患甲状腺癌的风险。因此，胰岛素抵抗可能在肥胖与甲状腺癌之间观察到的关联中起着关键作用，通过其与包括胰岛素样生长因子-1、脂肪细胞因子/细胞因子和促甲状腺激素在内的其他因素的相互联系，可能导致甲状腺癌的发生和/或进展。在本综述中，对肥胖与甲状腺癌风险之间拟议关联的流行病学和临床证据以及潜在机制进行了综述。如果观察性研究中显示的肥胖与甲状腺癌之间的关联被证明具有因果关系，那么针对肥胖（和/或风险的下游介质）可能对甲状腺癌的预防和管理具有重要意义。
