Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, Stony Brook, New York.
Department of Family, Population and Preventive Medicine, Stony Brook University, Medical Center, Stony Brook, New York.
Surg Obes Relat Dis. 2020 Oct;16(10):1586-1595. doi: 10.1016/j.soard.2020.06.026. Epub 2020 Jun 27.
Although bariatric surgery has been associated with a reduction in risk of obesity-related cancer, data on the effect of bariatric interventions on other cancers are limited.
This study aimed to examine the relationship between bariatric interventions and the incidence of various cancers after bariatric surgery.
Administrative statewide database.
The New York Statewide Planning and Research Cooperative System database was used to identify all adult patients diagnosed with obesity between 2006 and 2012 and patients who underwent bariatric procedures without preexisting cancer diagnosis and alcohol or tobacco use. Subsequent cancer diagnoses were captured up to 2016. Multivariable proportional subdistribution hazard regression analysis was performed to compare the risk of having cancer among obese patients with and without bariatric interventions.
We identified 71,000 patients who underwent bariatric surgery and 323,197 patients without a bariatric intervention. Patients undergoing bariatric surgery were less likely to develop both obesity-related cancer (hazard ratio.91; 95% confidence interval, .85-.98; P = .013) and other cancers (hazard ratio .81; 95% confidence interval, .74-.89; P < .0001). Patients undergoing Roux-en-Y gastric bypass had a lower risk of developing cancers that are considered nonobesity related (hazard ratio .59; 95% confidence interval, .42-.83; P = .0029) compared with laparoscopic sleeve gastrectomy.
Bariatric surgery is associated with a decreased risk of obesity-related cancers. More significantly, we demonstrated the relationship between bariatric surgery and the reduction of the risk of some previously designated nonobesity-related cancers, as well. Reclassification of nonobesity-related cancers and expansion of bariatric indications for reducing the risk of cancer may be warranted.
尽管减重手术与肥胖相关癌症风险降低有关，但关于减重干预对其他癌症影响的数据有限。
本研究旨在探讨减重手术后，减重干预与各种癌症发病之间的关系。
全州行政数据库。
利用纽约州全州规划和研究合作系统数据库，确定了 2006 年至 2012 年间诊断为肥胖的所有成年患者，以及未患有癌症且无酒精或烟草使用史的患者。随后的癌症诊断结果可追溯至 2016 年。采用多变量比例亚分布风险回归分析比较了接受和未接受减重干预的肥胖患者癌症发病风险。
共纳入 71000 例接受减重手术的患者和 323197 例未接受减重干预的患者。接受减重手术的患者发生肥胖相关癌症（风险比，0.91；95%置信区间，0.85-0.98；P =.013）和其他癌症（风险比，0.81；95%置信区间，0.74-0.89；P <.0001）的风险均较低。与腹腔镜袖状胃切除术相比，胃旁路术（Roux-en-Y gastric bypass）患者发生非肥胖相关癌症的风险较低（风险比，0.59；95%置信区间，0.42-0.83；P =.0029）。
减重手术与肥胖相关癌症风险降低有关。更重要的是，我们还证明了减重手术与一些先前指定的非肥胖相关癌症风险降低之间的关系。可能需要对非肥胖相关癌症进行重新分类，并扩大减重手术的适应证以降低癌症风险。
