Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Cleveland, Ohio.
Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio.
JAMA. 2022 Jun 28;327(24):2423-2433. doi: 10.1001/jama.2022.9009.
Obesity increases the incidence and mortality from some types of cancer, but it remains uncertain whether intentional weight loss can decrease this risk.
To investigate whether bariatric surgery is associated with lower cancer risk and mortality in patients with obesity.
DESIGN, SETTING, AND PARTICIPANTS: In the SPLENDID (Surgical Procedures and Long-term Effectiveness in Neoplastic Disease Incidence and Death) matched cohort study, adult patients with a body mass index of 35 or greater who underwent bariatric surgery at a US health system between 2004 and 2017 were included. Patients who underwent bariatric surgery were matched 1:5 to patients who did not undergo surgery for their obesity, resulting in a total of 30 318 patients. Follow-up ended in February 2021.
Bariatric surgery (n = 5053), including Roux-en-Y gastric bypass and sleeve gastrectomy, vs nonsurgical care (n = 25 265).
Multivariable Cox regression analysis estimated time to incident obesity-associated cancer (a composite of 13 cancer types as the primary end point) and cancer-related mortality.
The study included 30 318 patients (median age, 46 years; median body mass index, 45; 77% female; and 73% White) with a median follow-up of 6.1 years (IQR, 3.8-8.9 years). The mean between-group difference in body weight at 10 years was 24.8 kg (95% CI, 24.6-25.1 kg) or a 19.2% (95% CI, 19.1%-19.4%) greater weight loss in the bariatric surgery group. During follow-up, 96 patients in the bariatric surgery group and 780 patients in the nonsurgical control group had an incident obesity-associated cancer (incidence rate of 3.0 events vs 4.6 events, respectively, per 1000 person-years). The cumulative incidence of the primary end point at 10 years was 2.9% (95% CI, 2.2%-3.6%) in the bariatric surgery group and 4.9% (95% CI, 4.5%-5.3%) in the nonsurgical control group (absolute risk difference, 2.0% [95% CI, 1.2%-2.7%]; adjusted hazard ratio, 0.68 [95% CI, 0.53-0.87], P = .002). Cancer-related mortality occurred in 21 patients in the bariatric surgery group and 205 patients in the nonsurgical control group (incidence rate of 0.6 events vs 1.2 events, respectively, per 1000 person-years). The cumulative incidence of cancer-related mortality at 10 years was 0.8% (95% CI, 0.4%-1.2%) in the bariatric surgery group and 1.4% (95% CI, 1.1%-1.6%) in the nonsurgical control group (absolute risk difference, 0.6% [95% CI, 0.1%-1.0%]; adjusted hazard ratio, 0.52 [95% CI, 0.31-0.88], P = .01).
Among adults with obesity, bariatric surgery compared with no surgery was associated with a significantly lower incidence of obesity-associated cancer and cancer-related mortality.
重要提示：肥胖会增加某些类型癌症的发病率和死亡率，但目前仍不确定是否可以通过有计划的减肥来降低这种风险。
目的：调查肥胖患者接受减重手术是否与降低癌症风险和死亡率相关。
设计、地点和参与者：在 SPLENDID（外科手术与长期有效性对肿瘤疾病发病率和死亡率的影响）匹配队列研究中，纳入了在美国医疗系统中于 2004 年至 2017 年期间接受过体重指数为 35 或更高的减重手术的成年患者。与接受减重手术的患者进行 1:5 匹配，以找到未因肥胖而接受手术的患者，最终共纳入了 30318 名患者。随访于 2021 年 2 月结束。
暴露因素：接受减重手术（n=5053），包括 Roux-en-Y 胃旁路术和袖状胃切除术，与未接受手术治疗的肥胖患者（n=25265）进行对比。
主要结果和测量指标：多变量 Cox 回归分析估计肥胖相关癌症（包括 13 种癌症类型的复合终点）的发病时间和癌症相关死亡率。
结果：这项研究共纳入了 30318 名患者（中位年龄为 46 岁；中位体重指数为 45；77%为女性；73%为白人），中位随访时间为 6.1 年（IQR，3.8-8.9 年）。10 年后两组间的平均体重差异为 24.8kg（95%CI，24.6-25.1kg）或减重手术组的体重减轻了 19.2%（95%CI，19.1%-19.4%）。随访期间，减重手术组中有 96 名患者和非手术对照组中有 780 名患者发生肥胖相关癌症（发生率分别为每 1000 人年 3.0 例和 4.6 例）。10 年时主要终点的累积发生率在减重手术组为 2.9%（95%CI，2.2%-3.6%），在非手术对照组为 4.9%（95%CI，4.5%-5.3%）（绝对风险差异，2.0%[95%CI，1.2%-2.7%]；调整后的危险比，0.68[95%CI，0.53-0.87]，P=0.002）。减重手术组有 21 名患者和非手术对照组有 205 名患者发生癌症相关死亡（发生率分别为每 1000 人年 0.6 例和 1.2 例）。10 年时癌症相关死亡率的累积发生率在减重手术组为 0.8%（95%CI，0.4%-1.2%），在非手术对照组为 1.4%（95%CI，1.1%-1.6%）（绝对风险差异，0.6%[95%CI，0.1%-1.0%]；调整后的危险比，0.52[95%CI，0.31-0.88]，P=0.01）。
结论：在肥胖成年人中，与不手术相比，减重手术与肥胖相关癌症和癌症相关死亡率的显著降低相关。
