Harborg Sixten, Kjærgaard Kasper A, Thomsen Reimar Wernich, Borgquist Signe, Cronin-Fenton Deirdre, Hjorth Cathrine F
Department of Oncology, Aarhus University Hospital, 8200 Aarhus N, Denmark.
Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University Hospital, Aarhus University, 8200 Aarhus N, Denmark.
J Clin Endocrinol Metab. 2024 Mar 15;109(4):924-935. doi: 10.1210/clinem/dgad450.
The global prevalence of obesity and diabetes mellitus has increased in parallel with increasing cancer incidence, due to environmental and lifestyle factors and population aging. Metabolic diseases are associated with increased cancer risk, so a growing number of patients with cancer have coexistent obesity and/or diabetes mellitus. In this narrative review, we highlight recent evidence on the clinical impact of obesity and diabetes mellitus on the prognosis of prostate, breast, and colorectal cancer, and provide an overview of the underlying mechanisms. There is evidence that obesity is associated with increased risk of recurrence, and all-cause and cancer-specific mortality among adults with prostate, breast, and colorectal cancer. Diabetes mellitus is associated with increased all-cause and cancer-specific mortality for these 3 cancers, beyond any impact of obesity. Evidence also suggests increased risk of colorectal cancer recurrence in patients with diabetes mellitus. The underlying mechanisms are multifactorial and likely include hormonal imbalances and chronic inflammation that promote cancer cell growth. Obesity and diabetes mellitus are associated with increased risk of complications and side effects of cancer treatment. Associated comorbidities such as impaired kidney function, cardiovascular disease, and neuropathies may preclude the use of guideline cancer treatment and are competing causes of death. Cancer patients with metabolic diseases require a designated clinical program and a multidisciplinary approach involving oncologists, endocrinologists, surgeons, nutritionists, and physiotherapists, to ensure coordinated and optimized patient care.
由于环境、生活方式因素以及人口老龄化，全球肥胖症和糖尿病的患病率与癌症发病率同步上升。代谢性疾病与癌症风险增加相关，因此越来越多的癌症患者同时患有肥胖症和/或糖尿病。在这篇叙述性综述中，我们重点介绍了肥胖症和糖尿病对前列腺癌、乳腺癌和结直肠癌预后的临床影响的最新证据，并概述了潜在机制。有证据表明，肥胖与前列腺癌、乳腺癌和结直肠癌成年患者的复发风险增加以及全因死亡率和癌症特异性死亡率升高相关。糖尿病与这三种癌症的全因死亡率和癌症特异性死亡率增加相关，且超出了肥胖的任何影响。证据还表明，糖尿病患者结直肠癌复发风险增加。潜在机制是多因素的，可能包括促进癌细胞生长的激素失衡和慢性炎症。肥胖症和糖尿病与癌症治疗的并发症和副作用风险增加相关。相关的合并症，如肾功能受损、心血管疾病和神经病变，可能会妨碍使用指南推荐的癌症治疗方法，并且是相互竞争的死亡原因。患有代谢性疾病的癌症患者需要一个指定的临床项目以及包括肿瘤学家、内分泌学家、外科医生、营养师和物理治疗师在内的多学科方法，以确保为患者提供协调和优化的护理。
