De ce trebuie sa slabeasca pacientele cu cancer mamar?

  1. nutritie cancer mamar
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Ai fost diagnosticata cu cancer de san?


Iata de ce trebuie sa slabesti daca esti supraponderala sau obeza sau daca erai normoponderala dar te-ai ingrasat pe parcursul tratamentului:


a) Obezitatea scade eficienta tratamentului oncologic in cazul pacientelor cu cancer de san:


  1. Pacientele obeze cu cancer de san triplu negativ fara afectare ganglionara au un prognostic mai prost decat pacientele normoponderale –Bonsang-Kitzis si colab., 2015
  2. Raspunsul la chimioterapia neoadjuvanta este mai scazut in cazul pacientelor supraponderale si obeze cu cancer de san non-metastatic –Litton si colab., 2008
  3. Obezitatea este un factor de prognostic negativ independent care scade sansele de obtinere a raspunsului patologic complet la chimioterapia neoadjuvanta si durata de supravietuire a pacientelor carora nu li s-a administrat chimioterapie inainte de interventia chirurgicala – Karatas și colab., 2017
  4. Obezitatea scade supravietuirea pacientelor cu cancer de san ER+/PR±/HER2+ scazand raspunsul la tratamentul cu Tamoxifen si Herceptin –Pande si colab., 2014
  5. Cresterea ponderala pe parcursul chimioterapiei creste riscul de recurenta si mortalitate. – Thivat, 2010
  6. Eficienta tratamentelor cu inhibitori de aromataza este mai scazuta in cazul pacientelor obeze aflate la menopauza la momentul diagnosticului –Ioannides si colab. 2014
  7. Obezitatea asociaza un prognostic negativ independent de varsta si tipul de tratament, chiar si in cazul pacientelor cu cancer mamar diagnosticat in stadii incipiente. – Robinson, Bell și Davis, 2014

b) Obezitatea creste incidenta si amplitudinea efectelor secundare generate de tratamentul oncologic:


  1. Obezitatea asociaza un risc crescut de durere persistenta dupa interventiile chirurgicale mamare. – Ding si colab., 2017
  2. Obezitatea creste riscul de complicatii dupa interventiile chirurgicale mamare. – Chen si colab., 2011
  3. Obezitatea creste riscul de limfedem secundar cancerului mamar. – DiSipio si colab., 2013
  4. Obezitatea creste riscul de toxicitate cutanata pe parcursul radioterapiei. – Kraus-Tiefenbacher si colab., 2012
  5. Obezitatea asociaza un risc crescut de depresie. – Ishii si colab., 2016
  6. Adipozitatea crescuta scade biodisponibilitatea vitaminei D. – Parikh si colab., 2004

c) Obezitatea creste riscul de metastaza in cazul pacientelor cu cancer de san:


  1. Obezitatea creste riscul de metastaza sis cade supravietuirea pacientelor cu cancere ER-/PR±/HER2+. – Mazarella si colab., 2013
  2. Obezitatea creste riscul de metastazelor pulmonare si hepatice, iar chimioterapia este mai eficienta in cazul pacientelor normoponderale –Osman si Hennessy, 2014
  3. Obezitatea creste riscul de metastaza – Strong si colab., 2015; Dowling si colab., 2016
  4. Obezitatea creste riscul de metastaze pulmonare –Nagahashi si colab., 2016
  5. Obezitatea creste riscul de metastaza si scade supravietuirea pacientelor cu cancer de san –Wu si colab., 2017


d) Obezitatea scade supravietuirea pacientelor cu cancer de san:


  1. Obezitatea este un factor independent care creste riscul de metastaze si mortalitate datorata cancerului de san, eficienta terapiilor adjvuvante fiind mai scazuta in cazul pacientelor supraponderale sau obeze – Ewertz si colab., 2010
  2. Obezitatea scade supravietuirea pacientelor cu cancer de san independent de afectarea ganglionara –Kaviani si colab., 2013
  3. Obezitatea si diabetul au un impact negative asupra duratei supravietuirii in cazul pacientelor cu cancer de san – Jiralerspong si colab., 2013
  4. Obezitatea reprezinta un factor de risc independent ce inrautateste prognosticul pacientelor cu cancer de san cu ER+/PR±/HER2- cu afectare ganglionara aflate la menopauza la momentul diagnosticului– Arce-Salinas si colab., 2014Scholtz si colab., 2015
  5. Obezitatea scade supravietuirea in cazul pacientelor < 40 de ani cu cancere mamare ER+. – Copson si colab., 2015
  6. Obezitatea creste riscul de mortalitate in cazul pacientelor cu cancer de san, prognosticul imbunatatindu-se in cazul in care pacientele pierd grasime nu in cazul in care scad in greutate prin infometare asociata cu deshidratare si perdere de masa musculara – Chan si Norat, 2015


Studii citate:


Arce-Salinas, C., et al. “Overweight and obesity as poor prognostic factors in locally advanced breast cancer patients.” Breast cancer research and treatment 146.1 (2014): 183-188.


Bonsang-Kitzis, Hélène, et al. “Beyond axillary lymph node metastasis, BMI and menopausal status are prognostic determinants for triple-negative breast cancer treated by neoadjuvant chemotherapy.” PloS one 10.12 (2015): e0144359.


Chan, Doris SM, and Teresa Norat. “Obesity and breast cancer: not only a risk factor of the disease.” Current treatment options in oncology 16.5 (2015): 1-17.


Chen, Catherine L., et al. “The impact of obesity on breast surgery complications.” Plastic and reconstructive surgery 128.5 (2011): 395e-402e.


Copson, E. R., et al. “Obesity and the outcome of young breast cancer patients in the UK: the POSH study.” Annals of Oncology 26.1 (2015): 101-112.


Ding, Yuan-Yuan, et al. “Body mass index and persistent pain after breast cancer surgery: findings from the women’s healthy eating and living study and a meta-analysis.” Oncotarget 8.26 (2017): 43332.


DiSipio, Tracey, et al. “Incidence of unilateral arm lymphoedema after breast cancer: a systematic review and meta-analysis.” The lancet oncology 14.6 (2013): 500-515.


Dowling, R. J. O., et al. “Abstract P2-02-09: Obesity associated factors are inversely associated with circulating tumor cells in metastatic breast cancer.” (2016): P2-02.


Ewertz, Marianne, et al. “Effect of obesity on prognosis after early-stage breast cancer.” Journal of Clinical Oncology 29.1 (2010): 25-31.


Ioannides, S. J., et al. “Effect of obesity on aromatase inhibitor efficacy in postmenopausal, hormone receptor-positive breast cancer: a systematic review.” Breast cancer research and treatment 147.2 (2014): 237-248.


Ishii, Shinya, et al. “The association between sarcopenic obesity and depressive symptoms in older Japanese adults.” PloS one 11.9 (2016): e0162898.


Jiralerspong, S., et al. “Obesity, diabetes, and survival outcomes in a large cohort of early-stage breast cancer patients.” Annals of oncology (2013): mdt224.


Kaviani, Ahmad, et al. “Effects of obesity on presentation of breast cancer, lymph node metastasis and patient survival: a retrospective review.” Asian Pac J Cancer Prev 14.4 (2013): 2225-9.


Karatas, Fatih, et al. “Obesity is an independent prognostic factor of decreased pathological complete response to neoadjuvant chemotherapy in breast cancer patients.” The Breast 32 (2017): 237-244.


Kraus-Tiefenbacher, Uta, et al. “Factors of influence on acute skin toxicity of breast cancer patients treated with standard three-dimensional conformal radiotherapy (3D-CRT) after breast conserving surgery (BCS).” Radiation Oncology 7.1 (2012): 217.


Litton, Jennifer K., et al. “Relationship between obesity and pathologic response to neoadjuvant chemotherapy among women with operable breast cancer.” Journal of Clinical Oncology 26.25 (2008): 4072-4077.


Mazzarella, Luca, et al. “Obesity increases the incidence of distant metastases in oestrogen receptor-negative human epidermal growth factor receptor 2-positive breast cancer patients.” European Journal of Cancer 49.17 (2013): 3588-3597.


Nagahashi, M., et al. “Abstract P2-05-11: Sphingosine-1-phosphate signaling promotes metastatic niches and lung metastasis in obesity-related breast cancer.” (2016): P2-05.


Osman, Mohammed A., and Bryan T. Hennessy. “Obesity Correlation With Metastases Development and Response to First-Line Metastatic Chemotherapy in Breast Cancer.” Clinical Medicine Insights. Oncology 9 (2014): 105-112.


Parikh, Shamik J., et al. “The relationship between obesity and serum 1, 25-dihydroxy


Pande, Mala, et al. “Association between germline single nucleotide polymorphisms in the PI3K-AKT-mTOR pathway, obesity, and breast cancer disease-free survival.” Breast cancer research and treatment 147.2 (2014): 381-387.


Robinson, P. J., Bell, R. J., & Davis, S. R. (2014). Obesity is associated with a poorer prognosis in women with hormone receptor positive breast cancer. Maturitas79(3), 279-286.


Scholz, Christoph, et al. “Obesity as an independent risk factor for decreased survival in node-positive high-risk breast cancer.” Breast cancer research and treatment 151.3 (2015): 569-576.


Strong, Amy L., et al. “Leptin produced by obese adipose stromal/stem cells enhances proliferation and metastasis of estrogen receptor positive breast cancers.” Breast Cancer Research 17.1 (2015): 112.


Thivat, Emilie, et al. “Weight change during chemotherapy changes the prognosis in non metastatic breast cancer for the worse.” BMC cancer 10.1 (2010): 648.


Wu, Yong, et al. “Aberrant phosphorylation of SMAD4 Thr277-mediated USP9x-SMAD4 interaction by free fatty acids promotes breast cancer metastasis.” Cancer Research (2017): canres-2012.


Despre Autor

Diana Artene

Sunt Nutritionist-Dietetician, Master in Nutritie si Doctor in Nutritie Oncologica, Nutritionist Sportiv acreditat de Societatea Internationala de Nutritie Sportiva si membru al American Society for Nutrition și al European Society of Medical Oncology.