Chlebowski Rowan T, Reeves Marina M
Rowan T. Chlebowski, Harbor-University of California, Los Angeles Medical Center, Torrance, CA; and Marina M. Reeves, The University of Queensland, Brisbane, Queensland, Australia.
J Clin Oncol. 2016 Dec 10;34(35):4238-4248. doi: 10.1200/JCO.2016.69.4026. Epub 2016 Nov 7.
Purpose Observational study evidence has associated overweight/obesity with decreased survival in women with breast cancer and with several other cancers. Although full-scale, definitive weight loss adjuvant intervention trials with cancer end points remain to be conducted, a number of randomized controlled trials have evaluated weight loss interventions in survivors of cancer in women. Findings from these trials in breast, endometrial, and ovarian cancer are reviewed. Methods A systematic review of randomized controlled clinical trials evaluating weight loss interventions was updated (for studies published 2013 to 2016), and clinical trials registers were searched for ongoing trials. Results Six new randomized trials in breast cancer survivors and two randomized trials in endometrial cancer survivors were identified. Evidence from these trials and the 10 earlier randomized trials in female cancer survivors provide support for the feasibility of recruiting women closer to the cancer diagnosis and efficacy for achieving weight loss, in particular with telephone-based interventions, and have identified the challenge of achieving significant weight loss in African American cancer survivors and of maintaining weight loss in any cancer survivor group. Seven ongoing randomized trials are evaluating the influence of weight loss interventions on cancer end points (five in breast cancer, one in ovarian cancer, and one in endometrial cancer). Conclusion After a decade of preliminary studies, ongoing randomized, controlled clinical trials will potentially provide definitive assessment of whether weight loss can improve breast cancer clinical outcome. Longer-term interventions (> 2 years' duration) may be needed to optimize weight loss maintenance and any potential benefits on cancer end points.
目的 观察性研究证据表明，超重/肥胖与乳腺癌及其他几种癌症女性患者的生存率降低有关。尽管仍有待开展以癌症终点为指标的全面、确定性减肥辅助干预试验，但已有多项随机对照试验评估了女性癌症幸存者的减肥干预措施。本文对这些在乳腺癌、子宫内膜癌和卵巢癌方面的试验结果进行了综述。方法 对评估减肥干预措施的随机对照临床试验进行了系统综述更新（针对2013年至2016年发表的研究），并在临床试验注册库中搜索正在进行的试验。结果 确定了6项针对乳腺癌幸存者的新随机试验和2项针对子宫内膜癌幸存者的随机试验。这些试验以及之前10项针对女性癌症幸存者的随机试验的证据支持了在更接近癌症诊断时招募女性的可行性以及减肥的有效性，特别是基于电话的干预措施，同时也发现了非裔美国癌症幸存者实现显著减肥以及任何癌症幸存者群体维持减肥效果方面的挑战。7项正在进行的随机试验正在评估减肥干预措施对癌症终点的影响（5项针对乳腺癌，1项针对卵巢癌，1项针对子宫内膜癌）。结论 经过十年的初步研究，正在进行的随机对照临床试验可能会对减肥是否能改善乳腺癌临床结局提供确定性评估。可能需要长期干预（持续时间>2年）来优化体重维持以及对癌症终点的任何潜在益处。
