免疫治疗给肿瘤患者带来了希望,但目前,在抗肿瘤治疗中不论是免疫单药还是联合治疗的疗效尚不理想,筛选优 势人群是提高患者临床获益以及减少临床并发症的重要手段。 随着经济发展,在中国乃至全世界,肥胖人群的比例日益增 大,已经成为一个公共卫生难题。 肥胖可能影响肿瘤患者免疫治疗的疗效,成为筛选免疫治疗获益人群的有效特征,但其机 制尚不明确。 在临床前研究中,肥胖从引起慢性炎症、促进免疫抑制的肿瘤微环境产生、脂肪因子分泌紊乱以及减少肠道菌 群中的有益菌种等多个方面导致免疫抑制并促进肿瘤进展,然而,许多临床研究中却显示肥胖人群能从肿瘤免疫治疗中获益 更多,即“肥胖悖论”。 本文从临床研究和临床前研究两个方面阐述了肥胖对免疫治疗疗效的影响以及可能的机制,探讨导致 “肥胖悖论”产生的可能原因,以期提高免疫治疗的疗效,探究未来可能的研究方向和理论基础。

Immunotherapy brings hope to cancer patients but the clinical outcome of cancer immunotherapy monotherapy or combined therapy is not ideal. Screening the dominant population is an important means to improve the clinical benefit of patients and reduce clinical complications. With economic development the proportion of obese people in China and the world is increasing which has become a public health problem. There is growing evidence that obesity may affect the efficacy of immunotherapy and it has become an effective feature for screening immunotherapy -beneficial populations but the mechanism remains unclear. The 􀆵 obesity paradox refers to the fact that obesity leads to immunosuppression and promotes tumor progression in preclinical studies via chronic inflammation the creation of an immunosuppressive tumor microenvironment disturbance of adipokines secretion and reduction of beneficial bacteria in the gut microbiota but the clinical studies show that obese people can benefit more from immunotherapy. In order to provide research directions and theoretical basis to explore the real impact of obesity status on the efficacy of immunotherapy in the future and to improve the efficacy of immunotherapy we reviewed the impact of obesity on the efficacy of immunotherapy from both clinical and preclinical studies and proposed possible explanations for the 􀆵obesity paradox .