Gild Philipp, Ehdaie Behfar, Kluth Luis A
aCenter for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA bDepartment of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany cUrology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
Curr Opin Urol. 2017 Sep;27(5):409-414. doi: 10.1097/MOU.0000000000000425.
The prevalence of obesity has risen dramatically in the general population and among cancer survivors in the last three decades. In this review, we highlight the impact of obesity on carcinogenesis and survival with a focus on bladder cancer and renal cell carcinoma (RCC).
Obesity presents an established risk factor for an up to 1.8-fold relative risk of RCC. Data with regard to bladder cancer are less abundant but support this association as well. Possible biological mechanisms involved are the insulin/insulin-like growth factor pathway, sex steroids, adipokines and chronic inflammation as well as treatment disparities within normal weight versus obese patients. With regard to survival, no conclusion can be drawn in either tumor entity at this time because of contradictory findings. These can in part be attributed to methodological limitations, while at the same time data exist to support the notion that obese patients exhibit less aggressive tumors.
Obesity drives cancer risk in RCC and potentially bladder cancer. Evidence regarding survival has been contradictory and therefore no clear-cut recommendation can be made regarding weight management in cancer survivors despite to maintain a healthy lifestyle. However, given the future cancer burden that obesity will constitute, physicians should encourage weight loss and help prevent weight gain in the general population.
在过去三十年中,肥胖在普通人群和癌症幸存者中的患病率急剧上升。在本综述中,我们重点关注肥胖对致癌作用和生存的影响,尤其关注膀胱癌和肾细胞癌(RCC)。
肥胖是RCC相对风险高达1.8倍的既定危险因素。关于膀胱癌的数据较少,但也支持这种关联。可能涉及的生物学机制包括胰岛素/胰岛素样生长因子途径、性激素、脂肪因子和慢性炎症,以及正常体重与肥胖患者之间的治疗差异。关于生存情况,由于研究结果相互矛盾,目前在这两种肿瘤类型中都无法得出结论。这些部分可归因于方法学上的局限性,同时也有数据支持肥胖患者肿瘤侵袭性较低的观点。
肥胖会增加RCC以及潜在的膀胱癌的发病风险。关于生存的证据相互矛盾,因此尽管建议癌症幸存者保持健康的生活方式,但在体重管理方面无法给出明确的建议。然而,考虑到肥胖将带来的未来癌症负担,医生应鼓励普通人群减肥并预防体重增加。