Fernandez Cornelius J, George Annu Susan, Subrahmanyan Nikhila A, Pappachan Joseph M
Department of Endocrinology and Metabolism, Pilgrim Hospital, United Lincolnshire Hospitals NHS Trust, Boston PE21 9QS, United Kingdom.
Department of Medical Oncology, VPS Lakeshore Hospital, Cochin 682040, India.
World J Methodol. 2021 May 20;11(3):23-45. doi: 10.5662/wjm.v11.i3.23.
There exists a complex interaction between obesity, type 2 diabetes mellitus (T2DM) and cancer, and an increase in the incidence of cancer is expected with the growing obesity-diabetes pandemic. The association of cancer with diabetes mellitus and obesity appears to be site-specific, the highest risk being for post-menopausal breast cancer, endometrial cancer, and colorectal cancer. Moreover, there is worsening of hyperglycaemia with the onset of cancer, evidencing a bi-directional link between cancer and diabetes mellitus and the need for monitoring for diabetes in cancer survivors. In this review, we look at the epidemiological evidence from observational studies and Mendelian randomization studies linking obesity, diabetes, and cancer, as well as the complex pathophysiological mechanisms involved, including insulin resistance with associated hyperinsulinaemia, the effect of chronic low-grade inflammation, and the effect of various adipokines that are associated with obesity and T2DM. Additionally, we describe the novel therapeutic strategies, based on their role on the discrete pathophysiological mechanisms involved in the tumourigenesis.
肥胖、2型糖尿病（T2DM）与癌症之间存在复杂的相互作用，随着肥胖 - 糖尿病大流行的加剧，癌症发病率预计会上升。癌症与糖尿病和肥胖的关联似乎具有部位特异性，绝经后乳腺癌、子宫内膜癌和结直肠癌的风险最高。此外，癌症发病时血糖会恶化，这证明了癌症与糖尿病之间的双向联系以及癌症幸存者监测糖尿病的必要性。在本综述中，我们审视了观察性研究和孟德尔随机化研究中关于肥胖、糖尿病与癌症的流行病学证据，以及其中涉及的复杂病理生理机制，包括胰岛素抵抗及相关的高胰岛素血症、慢性低度炎症的影响，以及与肥胖和T2DM相关的各种脂肪因子的影响。此外，我们根据其在肿瘤发生所涉及的离散病理生理机制中的作用，描述了新的治疗策略。
