Clapp Benjamin, Portela Ray, Sharma Ishna, Nakanishi Hayato, Marrero Katie, Schauer Philip, Halfdanarson Thorvardur R, Abu Dayyeh Barham, Kendrick Michael, Ghanem Omar M
Department of Surgery, Texas Tech HSC Paul Foster School of Medicine, El Paso, Texas, USA.
Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA.
Br J Surg. 2022 Dec 13;110(1):24-33. doi: 10.1093/bjs/znac343.
BACKGROUND: Obesity is associated with an increased incidence of at least 13 types of cancer. Although bariatric surgery has been associated with a reduced risk of hormonal cancers, data for non-hormonal cancers are scarce. The aim of this study was to evaluate the effect of bariatric surgery on the incidence of non-hormonal cancers. METHODS: Cochrane, Embase, PubMed, Scopus, and Web of Science were searched for articles between 1984 and 2018, following the PRISMA system. Meta-analysis was conducted using a random-effect model with subgroup analysis by procedure and cancer type. RESULTS: From 2526 studies screened, 15 were included. There were a total of 18 583 477 patients, 947 787 in the bariatric group and 17 635 690 in the control group. In comparison to the non-surgical group, the bariatric group had a lower incidence of cancer (OR .65 (95 per cent c.i. 0.53 to 0.80); P < 0.002). In the subgroup analysis, Roux-en-Y gastric bypass and sleeve gastrectomy were associated with decreased risk of developing cancer, while no difference was observed with adjustable gastric banding. When evaluated by cancer type, liver (OR 0.417 (95 per cent c.i. 0.323 to 0.538)), colorectal (OR 0.64 (95 per cent c.i. 0.49 to 0.84)), kidney and urinary tract cancer (OR 0.77 (95 per cent c.i. 0.72 to 0.83)), oesophageal (OR 0.60 (95 per cent c.i. 0.43 to 0.85)), and lung cancer (OR 0.796 (95 per cent c.i. 0.45 to 0.80)) also presented a lower cancer incidence in the bariatric group. CONCLUSION: Bariatric surgery is related to an almost 50 per cent reduction in the risk of non-hormonal cancers.
背景:肥胖与至少13种癌症的发病率增加相关。尽管减肥手术与激素相关癌症风险降低有关,但非激素相关癌症的数据却很匮乏。本研究旨在评估减肥手术对非激素相关癌症发病率的影响。 方法:按照PRISMA系统,检索Cochrane、Embase、PubMed、Scopus和Web of Science数据库中1984年至2018年期间的文章。采用随机效应模型进行荟萃分析,并按手术方式和癌症类型进行亚组分析。 结果:在筛选的2526项研究中,纳入了15项。共有18583477例患者,减肥手术组947787例,对照组17635690例。与非手术组相比,减肥手术组癌症发病率较低(比值比0.65(95%置信区间0.53至0.80);P<0.002)。在亚组分析中,Roux-en-Y胃旁路术和袖状胃切除术与患癌风险降低相关,而可调节胃束带术未观察到差异。按癌症类型评估时,减肥手术组中肝癌(比值比0.417(95%置信区间0.323至0.538))、结直肠癌(比值比0.64(95%置信区间0.49至0.84))、肾及泌尿系统癌症(比值比0.77(95%置信区间0.72至0.83))、食管癌(比值比0.60(95%置信区间0.43至0.85))和肺癌(比值比0.796(95%置信区间0.45至0.80))的发病率也较低。 结论:减肥手术与非激素相关癌症风险降低近50%有关。
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