Ishihara Beatriz P, Farah Daniela, Fonseca Marcelo C M, Nazario Afonso
Department of Gynecology, Federal University of Sao Paulo, Sao Paulo, Brazil.
Department of Gynecology, Federal University of Sao Paulo, Sao Paulo, Brazil; Department of Gynecology, Health Technologies Assessment Center, Federal University of Sao Paulo, Sao Paulo, Brazil.
Surg Obes Relat Dis. 2020 Oct;16(10):1596-1602. doi: 10.1016/j.soard.2020.06.008. Epub 2020 Jun 14.
This article performs a systematic review and meta-analysis to investigate the impact of bariatric surgery and the risk of developing breast, ovarian, and endometrial cancer in obese women. MEDLINE, EMBASE, LILACS, and Cochrane databases were searched from inception until January 2019 to retrieve studies that assessed the risk of breast, ovarian, or endometrial cancer in obese women submitted to bariatric surgery. There was no language restriction. We extracted and combined data from studies to assess the risk ratio (RR) of developing these neoplasms. A random-effects meta-analytic model was applied in all calculations. The New Castle Ottawa and GRADE were used to assess quality of the included studies and certainty of the evidence, respectively. This study is registered in PROSPERO (CRD42019112927). We found 188 articles and 7 of those were included in our meta-analysis, which incorporated a total of 150,537 patients in the bariatric surgery arm and 1,461,938 women in the control arm. The total RR of breast, ovarian, and endometrial cancer was .41 (95% confidence interval [CI]: .31-.56]; I = 90%; 7 studies). The risk of breast cancer was reduced by 49% (RR: .51; 95%CI: .31-.83]; I = 92%; 6 studies). The risk of ovarian cancer was reduced by 53% (RR: .47; 95%CI: .27-81; I = 0%; 3 studies). The risk of endometrial cancer was reduced by 67% (RR: .33; 95%CI: .21-.51; I = 88%; 7 studies). Bariatric surgery may have a protective effect reducing the risk of breast, ovarian, and endometrial cancer in obese women. The high heterogeneity and other issues justify the need for further studies to deepen our knowledge.
本文进行了一项系统综述和荟萃分析，以研究减肥手术对肥胖女性患乳腺癌、卵巢癌和子宫内膜癌风险的影响。检索了MEDLINE、EMBASE、LILACS和Cochrane数据库，从建库至2019年1月，以获取评估接受减肥手术的肥胖女性患乳腺癌、卵巢癌或子宫内膜癌风险的研究。无语言限制。我们从研究中提取并合并数据，以评估发生这些肿瘤的风险比（RR）。所有计算均采用随机效应荟萃分析模型。分别使用纽卡斯尔渥太华量表和GRADE来评估纳入研究的质量和证据的确定性。本研究已在PROSPERO（CRD42019112927）注册。我们找到了188篇文章，其中7篇纳入了我们的荟萃分析，减肥手术组共纳入150,537例患者，对照组纳入1,461,938例女性。乳腺癌、卵巢癌和子宫内膜癌的总RR为0.41（95%置信区间[CI]：0.31 - 0.56；I² = 90%；7项研究）。乳腺癌风险降低了49%（RR：0.51；95%CI：0.31 - 0.83；I² = 92%；6项研究）。卵巢癌风险降低了53%（RR：0.47；95%CI：0.27 - 0.81；I² = 0%；3项研究）。子宫内膜癌风险降低了67%（RR：0.33；95%CI：0.21 - 0.51；I² = 88%；7项研究）。减肥手术可能具有保护作用，可降低肥胖女性患乳腺癌、卵巢癌和子宫内膜癌的风险。高度异质性和其他问题表明有必要进行进一步研究以加深我们的认识。
