Xu Yitong, Rogers Connie J
Intercollege Graduate Degree Program in Integrative and Biomedical Physiology, Huck Institutes of the Life Sciences, Huck Institutes of the Life Sciences, The Pennsylvania State University, University Park, PA, USA.
Department of Nutritional Sciences, Huck Institutes of the Life Sciences, The Pennsylvania State University, University Park, PA, USA.
Transl Cancer Res. 2020 Sep;9(9):5700-5731. doi: 10.21037/tcr.2020.03.38.
Cancer is a major public health issue worldwide. Lifestyle factors, such as body weight and physical activity (PA), significantly impact cancer risk and progression. There is strong evidence that PA reduces and obesity increases risk and mortality from numerous cancer types. Energy restriction (ER) in non-obese hosts significantly reduces tumor incidence in a variety of preclinical models, and reduces body weight and cardiometabolic risk factors in humans. Emerging data suggest that PA- and ER-induced changes in inflammatory and immune mediators may contribute to the cancer prevention effects of these interventions. A systematic literature search was conducted to identify studies that evaluated the impact of PA and ER on tumor and immune outcomes in humans and animal models. A total of 97 eligible studies were identified (68 studies reporting PA interventions and 30 studies reporting ER interventions). Thirty-one studies investigated the effect of PA on cancer immune outcomes using preclinical cancer models of breast (n=17, 55%), gastrointestinal (n=6, 19%), melanoma (n=4, 13%), and several other cancer types (n=4, 13%). Despite the heterogeneity in study designs, the majority of studies (n=23, 74%) reported positive effects of PA on tumor outcomes. Thirty-seven clinical studies investigated the effect of PA on cancer immune outcomes. None reported tumor outcomes, thus only immune outcomes were evaluated in these studies. PA studies were conducted in patients with breast (n=22, 59%), gastrointestinal (n=5, 14%), prostate (n=2, 5%), esophageal (n=1, 3%), lung (n=1, 3%) cancer, leukemia (n=1, 3%), or mixed cancer types (n=5, 14%). Twenty-two studies investigated the effect of ER interventions on cancer immune outcomes using preclinical cancer models including breast (n=5, 23%), gastrointestinal (n=5, 23%), lung (n=2, 9%), liver (n=2, 9%), pancreatic (n=2, 9%), and several other cancer types (n=6, 27%). Positive effects of ER on tumor outcomes were reported in 21 of 22 studies. Six clinical studies investigated the effect of ER (in combination with PA) on tumor immune outcomes in cancer patients with overweight or obesity. Five were conducted in breast cancer patients, and one recruited patients of a mix of cancer types. A wide range of immunological parameters including immune cell phenotype and function, cytokines, and other immune and inflammatory markers were assessed in multiple tissue compartments (blood, spleen, lymph nodes and tumor) in the included studies. Results from preclinical and clinical studies suggest that both PA and ER exert heterogeneous effects on circulating factors and systemic immune responses. PA + ER alters the gene expression profile and immune infiltrates in the tumor which may result in a reduction in immune suppressive factors. However, additional studies are needed to better understand the effect of PA and/or ER on immunomodulation, particularly in the tumor microenvironment (TME).
癌症是全球主要的公共卫生问题。生活方式因素,如体重和身体活动(PA),对癌症风险和进展有重大影响。有强有力的证据表明,身体活动可降低多种癌症类型的风险,而肥胖会增加这些癌症类型的风险和死亡率。非肥胖宿主中的能量限制(ER)在多种临床前模型中显著降低肿瘤发生率,并降低人类的体重和心血管代谢风险因素。新出现的数据表明,身体活动和能量限制引起的炎症和免疫介质变化可能有助于这些干预措施的癌症预防效果。进行了一项系统的文献检索,以确定评估身体活动和能量限制对人类和动物模型中肿瘤及免疫结果影响的研究。共确定了97项符合条件的研究(68项报告身体活动干预的研究和30项报告能量限制干预的研究)。31项研究使用乳腺癌(n = 17,55%)、胃肠道癌(n = 6,19%)、黑色素瘤(n = 4,13%)和其他几种癌症类型(n = 4,13%)的临床前癌症模型研究了身体活动对癌症免疫结果的影响。尽管研究设计存在异质性,但大多数研究(n = 23,74%)报告了身体活动对肿瘤结果有积极影响。37项临床研究调查了身体活动对癌症免疫结果的影响。没有一项报告肿瘤结果,因此这些研究仅评估了免疫结果。身体活动研究在乳腺癌(n = 22,59%)、胃肠道癌(n = 5,14%)、前列腺癌(n = 2,5%)、食管癌(n = 1,3%)、肺癌(n = 1,3%)、白血病(n = 1,3%)或混合癌症类型(n = 5,14%)患者中进行。22项研究使用包括乳腺癌(n = 5,23%)、胃肠道癌(n = 5,23%)、肺癌(n = 2,9%)、肝癌(n = 2,9%)、胰腺癌(n = 2,9%)和其他几种癌症类型(n = 6,27%)的临床前癌症模型研究了能量限制干预对癌症免疫结果的影响。22项研究中有21项报告了能量限制对肿瘤结果有积极影响。6项临床研究调查了能量限制(与身体活动相结合)对超重或肥胖癌症患者肿瘤免疫结果的影响。5项研究在乳腺癌患者中进行,1项研究招募了混合癌症类型的患者。在纳入的研究中,在多个组织部位(血液、脾脏、淋巴结和肿瘤)评估了广泛的免疫参数,包括免疫细胞表型和功能、细胞因子以及其他免疫和炎症标志物。临床前和临床研究的结果表明,身体活动和能量限制对循环因子和全身免疫反应均有不同的影响。身体活动 + 能量限制会改变肿瘤中的基因表达谱和免疫浸润,这可能导致免疫抑制因子减少。然而,需要更多的研究来更好地了解身体活动和/或能量限制对免疫调节的影响,特别是在肿瘤微环境(TME)中。
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