Adipositas aus viszeralonkologischer Perspektive

Zusammenfassung

Weltweit sind 40% der Erwachsenen von Übergewicht und Adipositas betroffen. Neben den bekannten adipositasassoziierten Komorbiditäten, wie Diabetes mellitus Typ 2, arteriellem Hypertonus oder der Steatosis hepatitis u. a., rückt der Einfluss eines erhöhten Körpergewichts auf das Risiko maligner Erkrankungen in den Fokus. Für mehr als 20 Tumorarten ist ein gewichtsabhängiger Prävalenzanstieg belegt, wobei die pathophysiologischen Einflüsse vielfältig sind und unterschiedlichste Aspekte der Tumorentstehung umfassen. Hier zu nennen sind chronische Entzündungsprozesse, Hyperinsulinämie und Insulinresistenz, verschiedene Wachstumsfaktoren und Geschlechtshormone. Auch im viszeralonkologischen Krankengut finden sich zahlreiche Tumoren, deren Erkrankungsrisiko mit dem Körpergewicht teilweise deutlich ansteigt. Dies zeigt sich u. a. beim kolorektalen Karzinom, hepatozellulären Karzinom, Adenokarzinom von Pankreas und Ösophagus sowie beim Kardiakarzinom. Da die Adipositas als grundsätzlich vermeidbare oder ursächlich behandelbare Krebsursache angesehen werden muss, beschäftigt sich diese Übersichtsarbeit zum einen mit dem Einfluss einer Adipositas auf die Prävalenz viszeralonkologisch relevanter Tumoren sowie deren Prävention und Therapie. Zum anderen wird die aktuelle Datenlage zum Einfluss adipositaschirurgischer Eingriffe auf die Tumorprävalenz dargestellt. Nach bariatrischen Eingriffen kann beim Adenokarzinom des Pankreas und beim hepatozellulären Karzinom eine deutlich geringere Malignomprävalenz beobachtet werden, gerade bei Letzterem kann dieser Effekt durch den mit der Gewichtsreduktion einhergehenden Rückgang der nicht alkoholischen Fettlebererkrankung (NAFLD) erklärt werden. Beim kolorektalen Karzinom hingegen zeigen die verfügbaren Daten ein eher inhomogenes Bild. Bei Malignomen des ösophagealen Übergangs wiederum wird, trotz der berechtigten Sorge, dass bariatrische Operationen (insbesondere die Schlauchmagenresektion) zu einer refluxbedingten erhöhten Prävalenz von Barrett-Karzinomen führen, keine relevante Erhöhung der Malignomrate beobachtet.

Abstract

Up to 40% of all adults worldwide are overweight or obese. Besides the established obesity-related comorbidities, such as type 2 diabetes mellitus, hypertension or NAFLD (non-alcoholic fatty liver disease), the focus of interest is shifting towards the influence of increased body weight as a risk factor for the development of malignant diseases. For more than 20 different types of malignancies, interactions between increased body weight and cancer risk have been established. Pathophysiological influences of obesity on carcinogenesis are diverse, including factors such as chronic inflammation, hyperinsulinaemia and insulin resistance, various changes in growth factor and changes in sex hormones. In cohorts of visceral oncology patients, malignancies such as colorectal carcinomas, hepatocellular carcinomas, adenocarcinomas of the pancreas, oesophageal and gastric carcinomas are also linked to an increased disease risk with increasing body weight. Since obesity must be considered a preventable or at least treatable cause of cancer, this review examines the influence of obesity in the field of visceral oncology, examining the effects of obesity on tumour prevalence, prevention and diagnostic testing, as well as its influence on treatment and prognosis. Furthermore, this review explores the current evidence on the influence of bariatric surgery on the prevalence of these obesity associated tumours. For example, in the case of colorectal carcinomas, the evidence base following bariatric surgery is mixed, painting an inhomogeneous picture. On the other hand, significantly lower prevalence of pancreatic adenocarcinoma and hepatocellular carcinomas is to be noted. The latter effect can be explained by the decrease in non-alcoholic fatty liver disease (NAFLD) associated with weight loss. Despite the justified concern that bariatric procedures (especially gastric sleeve resection) lead to increased prevalence of malignancies of the oesophageal junction, the currently available epidemiological data does not seem to identify a relevant increase in the incidence of these malignancies.

Schlüsselwörter

Krebs - Adipositas - Adipositaschirurgie

Keywords

cancer - obesity - bariatric surgery

Publication History

Received: 13 June 2022

Accepted after revision: 16 September 2022

Article published online:
07 December 2022

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