减重手术后的食管和胃癌风险。
Risk of Esophageal and Gastric Cancer After Bariatric Surgery.
机构信息
Department of General Surgery, Centre Hospitalier Intercommunal de Créteil, Créteil, France.
Institut National de la Santé et de la Recherche Médicale, Mondor Institute for Biomedical Research U955, Université Paris-Est Créteil, Créteil, France.
出版信息
JAMA Surg. 2023 Mar 1;158(3):264-271. doi: 10.1001/jamasurg.2022.6998.
IMPORTANCE
Bariatric surgery has been associated with a reduced risk of cancer in individuals with obesity. The association of bariatric surgery with esophageal and gastric cancer is still controversial, however.
OBJECTIVE
To compare the incidence of esophageal and gastric cancer between patients with obesity who underwent bariatric surgery and those who did not (control group).
DESIGN, SETTING, AND PARTICIPANTS: This cohort study obtained data from a national discharge database, including all surgical centers, in France from January 1, 2010, to December 31, 2017. Participants included adults (aged ≥18 years) with severe obesity who underwent bariatric surgery (surgical group) or who did not (control group). Baseline characteristics were balanced between groups using nearest neighbor propensity score matching with a 1:2 ratio. The study was conducted from March 1, 2020, to June 30, 2021.
EXPOSURES
Bariatric surgery (adjustable gastric banding, gastric bypass, and sleeve gastrectomy) vs no surgery.
MAIN OUTCOMES AND MEASURES
The main outcome was incidence of esophageal and gastric cancer. A secondary outcome was overall in-hospital mortality.
RESULTS
A total of 303 709 patients who underwent bariatric surgery (245 819 females [80.9%]; mean [SD] age, 40.2 [11.9] years) were matched 1:2 with 605 140 patients who did not receive surgery (500 929 females [82.8%]; mean [SD] age, 40.4 [12.5] years). After matching, the 2 groups of patients were comparable in terms of age, sex, and comorbidities (standardized mean difference [SD], 0.05 [0.11]), with some differences in body mass index. The mean follow-up time was 5.62 (2.20) years in the control group and 6.06 (2.31) years in the surgical group. A total of 337 patients had esophagogastric cancer: 83 in the surgical group and 254 in the control group. The incidence rates were 6.9 per 100 000 population per year for the control group and 4.9 per 100 000 population per year for the surgical group, resulting in an incidence rate ratio of 1.42 (95% CI, 1.11-1.82; P = .005). The hazard ratio (HR) of cancer incidence was significantly in favor of the surgical group (HR, 0.76; 95% CI, 0.59-0.98; P = .03). Overall mortality was significantly lower in the surgical group (HR, 0.60; 95% CI, 0.56-0.64; P < .001).
CONCLUSIONS AND RELEVANCE
In this large, nationwide cohort of patients with severe obesity, bariatric surgery was associated with a significant reduction of esophageal and gastric cancer incidence and overall in-hospital mortality, which suggests that bariatric surgery can be performed as treatment for severe obesity without increasing the risk of esophageal and gastric cancer.
重要性：减重手术与肥胖个体的癌症风险降低有关。然而，减重手术与食管癌和胃癌的相关性仍存在争议。
目的：比较接受减重手术和未接受手术（对照组）的肥胖患者中食管和胃癌的发病率。
设计、设置和参与者：本队列研究从法国全国性的出院数据库中获取了数据，包括 2010 年 1 月 1 日至 2017 年 12 月 31 日的所有外科中心。参与者包括接受减重手术的严重肥胖成年人（年龄≥18 岁）（手术组）或未接受手术的成年人（对照组）。通过 1:2 的最近邻倾向评分匹配来平衡组间的基线特征，匹配比为 1:2。该研究于 2020 年 3 月 1 日至 2021 年 6 月 30 日进行。
暴露因素：减重手术（可调节胃束带、胃旁路和袖状胃切除术）与未手术。
主要结果和测量指标：主要结果是食管和胃癌的发病率。次要结果是总体院内死亡率。
结果：共有 303709 名接受减重手术的患者（245819 名女性[80.9%]；平均[SD]年龄，40.2[11.9]岁）与 605140 名未接受手术的患者（500929 名女性[82.8%]；平均[SD]年龄，40.4[12.5]岁）进行了 1:2 匹配。匹配后，两组患者在年龄、性别和合并症方面具有可比性（标准化均差[SD]，0.05[0.11]），但体重指数存在一些差异。对照组的平均随访时间为 5.62（2.20）年，手术组为 6.06（2.31）年。共有 337 名患者患有食管胃癌症：手术组 83 例，对照组 254 例。对照组的发病率为每年每 100000 人口 6.9 例，手术组为每年每 100000 人口 4.9 例，发病率比为 1.42（95%CI，1.11-1.82；P=0.005）。癌症发病率的风险比（HR）明显有利于手术组（HR，0.76；95%CI，0.59-0.98；P=0.03）。手术组的总死亡率明显较低（HR，0.60；95%CI，0.56-0.64；P<0.001）。
结论和相关性：在这项针对严重肥胖患者的大型全国性队列研究中，减重手术与食管和胃癌的发病率显著降低以及整体院内死亡率降低相关，这表明减重手术可以作为严重肥胖症的治疗方法，而不会增加患食管癌和胃癌的风险。
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