Department of Molecular and Clinical medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
Institute of Health and Care Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
Diabetes Care. 2022 Feb 1;45(2):444-450. doi: 10.2337/dc21-1335.
Obesity and type 2 diabetes are associated with serious adverse health effects, including cancer. Although bariatric surgery has been shown to reduce cancer risk in patients with obesity, the effect of bariatric surgery on cancer risk in patients with obesity and diabetes is less studied. We therefore examined the long-term incidence of cancer after bariatric surgery and usual care in patients with obesity and diabetes in the matched prospective Swedish Obese Subjects (SOS) study.
The SOS study examines long-term outcomes following bariatric surgery or usual care. The current analysis includes 701 patients with obesity and type 2 diabetes at baseline, 393 of whom underwent bariatric surgery and 308 who received conventional obesity treatment. Information on cancer events was obtained from the Swedish National Cancer Register. Median follow-up time was 21.3 years (interquartile range 17.6-24.8 years, maximum 30.7 years).
During follow-up, the incidence rate for first-time cancer was 9.1 per 1,000 person-years (95% CI 7.2-11.5) in patients with obesity and diabetes treated with bariatric surgery and 14.1 per 1,000 person-years (95% CI 11.2-17.7) in patients treated with usual obesity care (adjusted hazard ratio 0.63 [95% CI 0.44-0.89], P = 0.008). Moreover, surgery was associated with reduced cancer incidence in women (0.58 [0.38-0.90], P = 0.016), although the sex-treatment interaction was nonsignificant (P = 0.630). In addition, diabetes remission at the 10-year follow-up was associated with reduced cancer incidence (0.40 [0.22-0.74], P = 0.003).
These results suggest that bariatric surgery prevents cancer in patients with obesity and diabetes and that durable diabetes remission is associated with reduced cancer risk.
肥胖和 2 型糖尿病与严重的健康不良后果相关，包括癌症。虽然减重手术已被证明可降低肥胖患者的癌症风险，但减重手术对肥胖和糖尿病患者的癌症风险的影响研究较少。因此，我们在匹配的前瞻性瑞典肥胖受试者（SOS）研究中检查了肥胖和糖尿病患者接受减重手术后和常规护理后的长期癌症发病率。
SOS 研究检查了减重手术后的长期结果或常规护理。当前分析包括基线时患有肥胖和 2 型糖尿病的 701 名患者，其中 393 名接受了减重手术，308 名接受了常规肥胖治疗。癌症事件的信息来自瑞典国家癌症登记处。中位随访时间为 21.3 年（四分位距 17.6-24.8 年，最长 30.7 年）。
在随访期间，接受减重手术治疗的肥胖和糖尿病患者的首次癌症发生率为每 1000 人年 9.1 例（95%CI7.2-11.5），接受常规肥胖治疗的患者为每 1000 人年 14.1 例（95%CI11.2-17.7）（校正后的危险比 0.63 [95%CI0.44-0.89]，P=0.008）。此外，手术与女性癌症发病率降低相关（0.58 [0.38-0.90]，P=0.016），尽管性别-治疗相互作用无统计学意义（P=0.630）。此外，10 年随访时糖尿病缓解与癌症发病率降低相关（0.40 [0.22-0.74]，P=0.003）。
这些结果表明，减重手术可预防肥胖和糖尿病患者的癌症，持久的糖尿病缓解与降低癌症风险相关。
