Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, Massachusetts, 02115, United States.
Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Obes Surg. 2019 Apr;29(4):1092-1098. doi: 10.1007/s11695-018-03701-7.
Bariatric surgery is associated with a reduced risk of developing certain malignancies, particularly in women. However, the impact of bariatric surgery on tumor characteristics, cancer treatment, and oncologic outcomes is unknown.
In a retrospective cohort study, 42 subjects diagnosed with breast cancer after bariatric surgery (1989-2014) were matched to 84 subjects with breast cancer (1984-2012) who did not undergo bariatric surgery, based on age, body mass index (BMI), and menopausal status at the time of breast cancer diagnosis, as well as the date of cancer diagnosis. Medical records were reviewed for cancer and bariatric endpoints. Statistical analysis was performed using mixed effects regression models, generalized estimating equation, conditional logistic regression, and Fisher's exact tests.
Women who developed breast cancer after bariatric surgery presented at an earlier stage compared to non-operated, obese controls. In the bariatric surgery group, there were fewer tumors with human epidermal growth factor receptor 2 overexpression (HER2+) (OR 0.16 (0.03-0.76); p = 0.02), with no significant differences seen in estrogen and progesterone receptor positivity. No HER2+ cancers were found in patients who underwent Roux-en-Y gastric bypass (OR 0.00 (0.00-0.43); p = 0.002). On multivariate analysis, bariatric surgery status remained associated with reduced HER2+ breast cancers (OR 0.18 (0.03-0.99); p < 0.05). At a mean follow-up of 5 years, bariatric surgery was associated with trends toward reduced cancer-specific and all-cause mortality.
Bariatric surgery is associated with reduced HER2+ breast cancers, suggesting that bariatric surgery can influence breast cancer characteristics and, potentially, tumor biology.
减重手术与某些恶性肿瘤风险降低相关，尤其是在女性中。然而，减重手术对肿瘤特征、癌症治疗和肿瘤学结果的影响尚不清楚。
在一项回顾性队列研究中，根据乳腺癌诊断时的年龄、体重指数（BMI）和绝经状态以及癌症诊断日期，对 42 名在减重手术后（1989-2014 年）被诊断为乳腺癌的患者与 84 名未接受减重手术的乳腺癌患者（1984-2012 年）进行了匹配。回顾性分析了癌症和减重手术的终点事件。采用混合效应回归模型、广义估计方程、条件逻辑回归和 Fisher 确切检验进行统计分析。
与未接受减重手术的肥胖对照组相比，减重手术后发生乳腺癌的女性患者在诊断时处于更早的分期。在减重手术组中，人表皮生长因子受体 2 过表达（HER2+）的肿瘤较少（OR 0.16（0.03-0.76）；p=0.02），雌激素和孕激素受体阳性率无显著差异。行 Roux-en-Y 胃旁路术的患者中未发现 HER2+癌症（OR 0.00（0.00-0.43）；p=0.002）。多变量分析显示，减重手术状态与 HER2+乳腺癌减少相关（OR 0.18（0.03-0.99）；p<0.05）。在平均 5 年的随访中，减重手术与癌症特异性和全因死亡率降低的趋势相关。
减重手术与减少的 HER2+乳腺癌相关，表明减重手术可以影响乳腺癌特征，并且可能影响肿瘤生物学。
