Programa de Pós-graduação em Ciências Médicas: Endocrinologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil.
Hospital de Clínicas de Porto Alegre, Porto Alegre, Brasil, Porto Alegre, RS, Brasil.
Arch Endocrinol Metab. 2023 Jun 19;67(6):e000647. doi: 10.20945/2359-3997000000647.
The proportion of deaths attributable to cancer is rising, and malignant neoplasms have become the leading cause of death in high-income countries. Obesity and diabetes are now recognized as risk factors for several types of malignancies, especially endometrial, colorectal, and postmenopausal breast cancers. Mechanisms implicated include disturbances in lipid-derived hormone secretion, sex steroids biosynthesis, hyperinsulinemia, and chronic inflammation. Intentional weight loss is associated with a mitigation of risk for obesity-related cancers, a phenomenon observed specially with bariatric surgery. The impact of pharmacological interventions for obesity and diabetes is not uniform: while metformin seems to protect against cancer, other agents such as lorcaserin may increase the risk of malignancies. However, these interpretations must be carefully considered, since most data stem from bias-prone observational studies, and high-quality randomized controlled trials with appropriate sample size and duration are needed to achieve definite conclusions. In this review, we outline epidemiological and pathophysiological aspects of the relationship between obesity, diabetes, and malignancies. We also highlight pieces of evidence regarding treatment effects on cancer incidence in these populations.
癌症导致的死亡比例正在上升，恶性肿瘤已成为高收入国家的主要死亡原因。肥胖症和糖尿病现在被认为是多种恶性肿瘤的危险因素，特别是子宫内膜癌、结直肠癌和绝经后乳腺癌。涉及的机制包括脂源性激素分泌紊乱、性激素生物合成、高胰岛素血症和慢性炎症。有目的的体重减轻与肥胖相关癌症的风险降低有关，这种现象在减肥手术中特别明显。肥胖症和糖尿病的药物干预的影响并不一致：虽然二甲双胍似乎可以预防癌症，但其他药物，如 lorcaserin，可能会增加恶性肿瘤的风险。然而，这些解释必须仔细考虑，因为大多数数据来自易产生偏差的观察性研究，需要进行具有适当样本量和持续时间的高质量随机对照试验，以得出明确的结论。在这篇综述中，我们概述了肥胖症、糖尿病和恶性肿瘤之间关系的流行病学和病理生理学方面。我们还强调了关于这些人群癌症发病率治疗效果的一些证据。
