Department of General Surgery, Centre Hospitalier Intercommunal de Créteil, Créteil, France.
INSERM IMRB U955, Université Paris-Est Créteil, Créteil, France.
Br J Surg. 2022 Apr 19;109(5):433-438. doi: 10.1093/bjs/znac003.
The impact of weight loss induced by bariatric surgery on cancer occurrence is controversial. To study the causal effect of bariatric surgery on cancer risk from an observational database, a target-trial emulation technique was used to mimic an RCT.
Data on patients admitted between 2010 and 2019 with a diagnosis of obesity were extracted from a national hospital discharge database. Criteria for inclusion included eligibility criteria for bariatric surgery and the absence of cancer in the 2 years following inclusion. The intervention arms were bariatric surgery versus no surgery. Outcomes were the occurrence of any cancer and obesity-related cancer; cancers not related to obesity were used as negative controls.
A total of 1 140 347 patients eligible for bariatric surgery were included in the study. Some 288 604 patients (25.3 per cent) underwent bariatric surgery. A total of 48 411 cancers were identified, including 4483 in surgical patients and 43 928 among patients who did not receive bariatric surgery. Bariatric surgery was associated with a decrease in the risk of obesity-related cancer (hazard ratio (HR) 0.89, 95 per cent c.i. 0.83 to 0.95), whereas no significant effect of surgery was identified with regard to cancers not related to obesity (HR 0.96, 0.91 to 1.01).
When emulating a target trial from observational data, a reduction of 11 per cent in obesity-related cancer was found after bariatric surgery.
减重手术引起的体重减轻对癌症发生的影响存在争议。为了从观察性数据库中研究减重手术对癌症风险的因果效应，使用目标试验模拟技术模拟 RCT。
从国家住院患者数据库中提取了 2010 年至 2019 年间诊断为肥胖的患者数据。纳入标准包括符合减重手术标准且纳入后 2 年内无癌症。干预组为减重手术与非手术。结局为任何癌症和肥胖相关癌症的发生；非肥胖相关癌症作为阴性对照。
共有 1 140 347 名符合减重手术条件的患者纳入研究。288 604 名（25.3%）患者接受了减重手术。共发现 48 411 例癌症，其中手术患者 4483 例，未接受减重手术的患者 43 928 例。减重手术与肥胖相关癌症风险降低相关（风险比（HR）0.89，95%置信区间 0.83 至 0.95），而手术对非肥胖相关癌症无显著影响（HR 0.96，0.91 至 1.01）。
从观察性数据模拟目标试验时，发现减重手术后肥胖相关癌症减少 11%。
