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Lancet Oncol：颠覆认知！男性肥胖患者活的更长？！

2018-02-14 Bonnie，Yui 转化医学网

男性肥胖寿命研究进展
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导 读 肥胖悖论是指有悖于原来的肥胖结论，肥胖未必缩短患者的预期存活时间，甚至在一些情况下可能反而产生“益处”。最近一项研究就显示，肥胖可增加转移性黑色素瘤患者的生存时间。


导  读

肥胖悖论是指有悖于原来的肥胖结论，肥胖未必缩短患者的预期存活时间，甚至在一些情况下可能反而产生“益处”。最近一项研究就显示，肥胖可增加转移性黑色素瘤患者的生存时间。

“肥胖悖论”最早出现于诸如心脏病和肾脏衰竭的慢性疾病研究中，也在肺炎这类急性感染病中出现过。一般认为，超重和肥胖会增加患癌风险，加速癌症发展。最近一项研究显示，接受靶向治疗或免疫治疗的转移性黑色素瘤肥胖患者的生存时间显著长于正常体重的患者，而且这种被称为“肥胖悖论”的作用主要表现的男性身上。
 
这项研究以“Association of body-mass index and outcomes in patients with metastatic melanoma treated with targeted therapy, immunotherapy, or chemotherapy: a retrospective, multicohort analysis”为题，发表于2月12日的《Lancet Oncology》上。

这项研究共纳入接受了靶向治疗、免疫疗法或者化疗的1918名患者，分析了六项独立临床队列的患者体重指数（BMI）、无进展生存期（PFS）和总生存期（OS）之间的联系。
 
两项队列研究接受靶向治疗的患者，其中接受dabrafenib联合trametinib 靶向治疗者599人，接受vemurafenib联合cobimetinib靶向治疗者240人；两项队列研究接受免疫疗法的患者，其中接受ipilimumab联合dacarbazine免疫疗法者 207人，接受pembrolizumab、nivolumab或atezolizumab 进行免疫治疗者331人；两项队列研究接受化疗的患者，分别为320人和221人。
 
在靶向治疗和免疫疗法的四组队列中，考虑到年龄、性别、治疗阶段、疾病负担、某些突变和既往治疗等因素的多变量分析显示，与正常BMI患者相比，肥胖患者的无进展生存期和总生存期得以延长。使用化疗治疗的两个队列中没有发现肥胖对于改善无进展生存期和总生存期的效果。


不同BMI的无进展生存期和总生存期

性别分析结果发现，肥胖仅仅改善了男性的无进展生存期和总生存期，对女性却无改善。


不同BMI和性别的总生存率

一直以来的研究表明，与男性相比，转移性黑色素瘤女性的结局更好。在这项研究中，男性因为肥胖提高了自身的生存期。当然，这项研究并不能证明肥胖治疗癌症的因果关系，并不能说，肥胖可以抑制癌症的发展，这只是给相关研究人员提出一个癌症治疗的方向。
 
“肥胖是许多疾病的一个风险因素，这是确定无疑的。”这项研究的通讯作者、德克萨斯大学MD安德森癌症中心的Jennifer McQuade博士说，“即使在我们所研究的转移性黑色素瘤患者群体中，我们也不会建议患者有意增重，我们需要弄清楚是什么推动了这种悖论，研究如何使用它使患者受益。”
 
目前，研究人员正在研究为什么肥胖可以帮助男性转移性黑色素瘤患者提高生存优势。
 
研究人员观察到的性别特异性指向一种荷尔蒙媒介。脂肪组织能够产生一种芳香酶，它能把雄激素转化为雌激素。McQuade说：“这或许可以帮助肥胖男性清除某种障碍，使他们获得更长的生存时间。”他正在与宾夕法尼亚大学的研究人员合作，他们发现在黑素瘤上开启一种特定类型的雌激素受体可使其易于接受免疫治疗。
 
这些研究人员还在研究基因表达、突变和免疫分析，以确定肥胖和非肥胖患者中黑素瘤的潜在差异，并开发临床前模型。
 
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    2018-09-26 howi

    #Lancet#

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=1829483, encodeId=bdf118294835c, content=<a href='/topic/show?id=1b6210686b2' target=_blank style='color:#2F92EE;'>#Lancet#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Wed Sep 26 19:56:00 CST 2018, time=2018-09-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1865341, encodeId=1df1186534121, content=<a href='/topic/show?id=16ce133504e' target=_blank style='color:#2F92EE;'>#Oncol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13350, encryptionId=16ce133504e, topicName=Oncol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b63894, createdName=minlingfeng, createdTime=Tue Oct 16 03:56:00 CST 2018, time=2018-10-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1950987, encodeId=e008195098e88, content=<a href='/topic/show?id=72078190803' target=_blank style='color:#2F92EE;'>#肥胖患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=19, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81908, encryptionId=72078190803, topicName=肥胖患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=28b7142, createdName=liuquan, createdTime=Fri Sep 21 19:56:00 CST 2018, time=2018-09-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=288146, encodeId=2ac42881465b, content=这一个研究存在很多偏倚.不能盲目相信., beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c4a5105539, createdName=lovetcm, createdTime=Thu Feb 15 09:56:33 CST 2018, time=2018-02-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=288044, encodeId=c7fa288044d7, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a8f22260741, createdName=121832a9m88暂无昵称, createdTime=Thu Feb 15 04:56:47 CST 2018, time=2018-02-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=288030, encodeId=953528803043, content=厉害了我的哥, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib3IzoRn621JdKCFUI4XvNELcibocrAVU6aUzEVDSaf3rYH08PUYUiagGqxAEhj8g9WqqNvD1CupIpCrmnR2OrqHZh/0, createdBy=7f181365728, createdName=飛歌, createdTime=Thu Feb 15 02:37:33 CST 2018, time=2018-02-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=288020, encodeId=8dbc2880209a, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/01/15/8213228fe923915543544ad3da7e1c64.jpg, createdBy=6bd82014262, createdName=秀红, createdTime=Thu Feb 15 01:04:13 CST 2018, time=2018-02-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=287996, encodeId=ae5428e99622, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ba101609906, createdName=happsf, createdTime=Wed Feb 14 23:20:00 CST 2018, time=2018-02-14, status=1, ipAttribution=)]
    2018-10-16 minlingfeng

    #Oncol#

    0

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    2018-09-21 liuquan

    #肥胖患者#

    0

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    2018-02-15 lovetcm

    这一个研究存在很多偏倚.不能盲目相信.

    0

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    2018-02-15 121832a9m88暂无昵称

    学习了

    0

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    2018-02-15 飛歌

    厉害了我的哥

    0

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    2018-02-15 秀红

    学习了

    0

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    2018-02-14 happsf

    学习

    0