O paradoxo da obesidade no câncer colorretal: evidências recentes sobre prognóstico e composição corporal
Nathalia Sernaglia Carvalho, Eliza Freitas Evangelista, Juliana Vieira Biason Bonometto, Auro del Giglio, Luiz Vinicius de Alcantara Sousa
Resumo
Introdução: A obesidade é reconhecida como fator de risco significativo para o desenvolvimento do câncer colorretal (CCR), sendo frequentemente associada a desfechos desfavoráveis. Entretanto, estudos apontam para um possível "paradoxo da obesidade", no qual pacientes com índice de massa corporal (IMC) elevado apresentam evolução clínica mais favorável. Objetivo: Analisar a influência da obesidade nos desfechos clínicos do CCR por meio de uma revisão integrativa da literatura. Métodos: Revisão integrativa conforme as diretrizes do PRISMA-ScR, com buscas sistematizadas na base de dados PubMed, considerando publicações entre 2020 e 2025 que respondessem à pergunta norteadora: "Pacientes obesos apresentam pior prognóstico no CCR?". Após triagem inicial de 95 artigos, 40 preencheram os critérios de inclusão para análise qualitativa. Resultados: Os parâmetros mais avaliados foram o IMC e a gordura visceral. Dentre os 18 estudos que utilizaram o IMC como indicador principal, 31,2% identificaram pior desfecho em pacientes com sobrepeso ou obesidade, 25% apontaram prognóstico mais favorável e 43,7% não encontraram associação estatisticamente significativa. Entre os 12 artigos que analisaram gordura visceral, 7 evidenciaram correlação com piores desfechos. Os demais trabalhos investigaram fatores como obesidade sarcopênica, inflamação crônica, perfis de expressão gênica e alterações no metabolismo lipídico. Conclusão: O excesso de gordura visceral, o IMC elevado e a baixa massa muscular esquelética foram consistentemente associados a desfechos oncológicos menos favoráveis. A inflamação sistêmica e o estado nutricional parecem atuar sinergicamente na evolução do CCR. As limitações do uso isolado do IMC como estratificador podem justificar parte do "paradoxo da obesidade". A avaliação prognóstica deve incorporar abordagens mais abrangentes e baseadas em evidências para aprimorar a estratificação de risco e contribuir para uma conduta clínica mais personalizada.
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Submetido em:
05/10/2025
Revisado em:
16/10/2025
Aceito em:
11/11/2025
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