Wei Yihui, Wong Simon K H, Wu Tingting, Law Betty T T, Ng Enders K W, Lam Cindy L K, Wong Carlos K H
Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
Department of Surgery, Prince of Wales Hospital, Hong Kong SAR, China.
J Diabetes. 2021 Nov;13(11):868-881. doi: 10.1111/1753-0407.13179. Epub 2021 Apr 14.
To examine risks of cancers, obesity-related cancers (eg, cancers in digestive organs, breast, ovary, kidney, thyroid, and myeloma), cancer-related mortality, and all-cause mortality in patients with type 2 diabetes mellitus (T2DM) and obesity who underwent bariatric surgery.
A retrospective cohort of 1944 T2DM patients with obesity (345 bariatric surgery patients and 1599 matched controls) who were free of cancer from 2006 to 2017 was assembled. One-to-five propensity score matching followed by propensity score trimming was used to balance baseline covariates.
During a mean follow-up period of 37 months, there are risks that in 3.2%, 1.4%, 0.9%, and 3.2% of bariatric patients cancer, obesity-related cancer, cancer-related mortality, and all-cause mortality, respectively, would occur. Surgical patients were found to have reduced incidence rates (IRs) of obesity-related cancer (0.531/100 person-years, 95% confidence interval [CI]: 0.172-1.238/100 person-years) and cancer of breast and genital organs (0.394/100 person-years, 95% CI: 0.048-1.424/100 person-years) than matched control patients whose IRs for obesity-related cancer and cancer of breast and genital organs were 0.627/100 person-years (95% CI: 0.426-0.889/100 person-years) and 0.521/100 person-years (95% CI: 0.277-0.891/100 person-years), respectively. Patients in the surgical group had a significant reduction in risk of all-cause mortality (hazard ratio [HR] = 0.508, P = .041). Effects of bariatric surgery on any cancers (HR = 1.254, P = .510), obesity-related cancers (HR = 0.843, P = .724), and cancer mortality (HR = 1.304, P = .694) were not significant.
Bariatric surgery was not associated with risks of overall cancer, obesity-related cancer, and cancer mortality among T2DM patients with obesity at 3 years.
研究接受减肥手术的2型糖尿病（T2DM）合并肥胖患者患癌症、肥胖相关癌症（如消化器官、乳腺、卵巢、肾脏、甲状腺癌及骨髓瘤）、癌症相关死亡率和全因死亡率的风险。
纳入1944例2006年至2017年期间无癌症的T2DM合并肥胖患者的回顾性队列（345例减肥手术患者和1599例匹配对照）。采用1:5倾向评分匹配并进行倾向评分修剪以平衡基线协变量。
在平均37个月的随访期内，减肥手术患者发生癌症、肥胖相关癌症、癌症相关死亡率和全因死亡率的风险分别为3.2%、1.4%、0.9%和3.2%。发现手术患者肥胖相关癌症（0.531/100人年，95%置信区间[CI]：0.172 - 1.238/100人年）以及乳腺和生殖器官癌症（0.394/100人年，95% CI：0.048 - 1.424/100人年）的发病率低于匹配对照患者，后者肥胖相关癌症以及乳腺和生殖器官癌症的发病率分别为0.627/100人年（95% CI：0.426 - 0.889/100人年）和0.521/100人年（95% CI：0.277 - 0.891/100人年）。手术组患者全因死亡率风险显著降低（风险比[HR]=0.508，P = 0.041）。减肥手术对任何癌症（HR = 1.254，P = 0.510）、肥胖相关癌症（HR = 0.843，P = 0.724）和癌症死亡率（HR = 1.304，P = 0.694）的影响不显著。
减肥手术与3年内肥胖的T2DM患者的总体癌症、肥胖相关癌症和癌症死亡率风险无关。
