Epidemiology studies have demonstrated a clear association between obesity and the development of several distinct malignancies, with excessive visceral adiposity being an increasingly prevalent feature in patients with cancer presenting for therapeutic intervention. Clinical trials and meta-analyses have helped to inform effective and safe dosing of traditional systemically administered anticancer agents in adult patients with cancer and obesity, but there remains much debate not only regarding the effect of obesity on the more novel targeted molecular and immune-based therapies, but also about how obesity is best defined and measured clinically. Low muscle mass is associated with poor outcomes in cancer, and body composition studies using biochemical and imaging modalities are helping to fully delineate the importance of both obesity and sarcopenia in clinical outcomes; such studies might also go some way to explaining how obesity can paradoxically be associated with favourable clinical outcomes in certain cancers. As the cancer survivorship period increases and the duration of anticancer treatment lengthens, this Review highlights the challenges facing appropriate treatment selection and emphasizes how a multidisciplinary approach is warranted to manage weight and skeletal muscle loss during and after cancer treatment.

流行病学研究表明，肥胖与几种不同恶性肿瘤的发展之间存在明显的关联，其中过度内脏肥胖是寻求治疗干预的癌症患者越来越普遍的特征。临床试验和荟萃分析有助于为成年癌症和肥胖患者有效和安全地服用传统的全身给药抗癌药物提供信息，但不仅关于肥胖对更新颖的靶向分子和免疫疗法的影响，而且关于如何最好地定义和测量肥胖仍然存在很多临床。低肌肉质量与癌症的不良预后相关，使用生化和成像方式的身体成分研究有助于充分描述肥胖和肌肉减少症在临床结果中的重要性;此类研究也可能在某种程度上解释了肥胖如何自相矛盾地与某些癌症的良好临床结果相关联。随着癌症生存期的增加和抗癌治疗持续时间的延长，本综述强调了适当治疗选择面临的挑战，并强调了如何保证多学科方法来管理癌症治疗期间和之后的体重和骨骼肌损失。