背景:已发现许多类型的癌症与超重或肥胖有关。文献表明,接受减肥手术的患者的癌症风险降低。
目的:比较新诊断癌症的发生率和类型,累积癌症发病率,癌症风险,以及接受减肥手术的肥胖患者与未接受减肥手术的肥胖患者的总体生存率。
方法:基于社区的学术医学中心。
方法:我们回顾性比较了减重手术队列(减重手术组)和非手术队列(比较组)中新发癌症的发生率和类型。比较组是从在每次减肥手术后30天内在我们的卫生系统进行临床访问的患者中选择,并在年龄上进行匹配,性别,和体重指数。在进行减肥手术之前诊断为癌症的患者被排除在减肥组之外,并且在临床就诊之前诊断为癌症的患者被匹配,被排除在对照组之外。按类型计算癌症的相对风险。卡方检验和Fisher精确检验用于分类数据分析,和Wilcoxon秩和用于连续数据。采用对数秩检验的KaplanMeier估计器比较各组间的总生存率。而竞争风险生存分析与Gray检验的相等性用于比较手术组和对照组的癌症发病率。
结果:匹配后,减重治疗组有1593例患者,对照组有2156例患者.减肥组和对照组有82和222例新的癌症事件,分别(P<.001)。减肥组任何新癌症的10年发病率为6.5%,与对照组的12.1%的发生率相比(P<.001)。减肥组的癌症相对风险低于对照组,子宫内膜差异最大(88.8%),肾脏(77.4%),甲状腺(72.9%),和导管原位癌(71.2%)。减重治疗组的10年总生存率高于对照组,93.3%对80.6%,分别(P<.001)。
结论:与未接受减肥手术的类似患者相比,减肥手术可降低患癌症的风险,并具有生存优势。
BACKGROUND: Many types of cancer have been found to be associated with being overweight or obese. Literature has demonstrated a reduction in cancer risk in patients who have undergone bariatric surgery.
OBJECTIVE: To compare the incidence and types of new cancer diagnoses, cumulative cancer incidence, cancer risk, and overall survival in patients with obesity who underwent bariatric surgery with that of those who did not.
METHODS: Community-based academic medical center.
METHODS: We retrospectively compared the rates and types of new incident cancers in a bariatric surgery cohort (Bariatric group) with those of a non-surgical cohort (Comparison group). The Comparison group was chosen from patients who had a clinic visit in our health system within 30 days of each bariatric surgical operation and matched on age, sex, and body mass index. Patients who had a cancer diagnosis prior to having bariatric surgery were excluded from the Bariatric group and patients who had a cancer diagnosis prior to the clinic visit on which they were matched were excluded from the Comparison group. Relative risk of cancer by type was calculated. Chi-square and Fisher exact tests were used for categorical data analysis, and Wilcoxon rank-sum for continuous data. The Kaplan Meier estimator with the log-rank test was used to compare overall survival between groups, while competing risks survival analysis with the Gray test for equality was used to compare cancer incidence in the Surgery group with that in the Comparison group.
RESULTS: After matching, the Bariatric group had 1593 patients and the Comparison group had 2156. The Bariatric and Comparison groups had 82 and 222 new incident cancer cases, respectively (P < .001). The 10-year incidence of any new cancer in the Bariatric group was 6.5%, compared with an incidence of 12.1% in the Comparison group (P < .001). Relative risk of cancer in the Bariatric group was lower than that of the Comparison group, with the greatest differences in endometrial (88.8%), kidney (77.4%), thyroid (72.9%), and ductal carcinoma in situ (71.2%) cancers. The 10-year overall survival rate was higher in the Bariatric group than in the Comparison group, 93.3% versus 80.6%, respectively (P < .001).
CONCLUSIONS: Bariatric surgery reduces the risk for developing cancer and offers survival advantage when compared with similar patients who do not undergo bariatric surgery.