美国克利夫兰诊所Steven E. Nissen团队研究了肥胖成人接受减肥手术与癌症风险和死亡率的相关性。2022年6月3日，《美国医学会杂志》发表了这一成果。

肥胖会增加某些类型癌症的发病率和死亡率，但仍不确定有目的地减肥是否能降低这种风险。

为了探讨减肥手术是否能降低肥胖患者的癌症风险和死亡率，研究组进行了一项SPLENDID（外科手术和肿瘤疾病发病率和死亡的长期有效性）配对队列研究，纳入2004-2017年间在美国卫生系统接受减肥手术的体重指数>=35的成年患者。

接受减肥手术的患者与未接受手术患者的比例为1:5，共招募了30318名患者。随访于2021年2月结束。5053名患者接受了减肥手术，包括Roux-en-Y胃旁路术和袖状胃切除术；25265名接受非手术治疗。多变量Cox回归分析估计了肥胖相关癌症的发病时间（以13种癌症类型为主要终点）和癌症相关死亡率。

30318名患者的平均年龄为46岁，平均体重指数为45，77%为女性，73%为白人，平均随访时间为6.1年。10年后减肥手术组的平均体重比非手术对照组减轻24.8 kg，或平均减轻19.2%。在随访期间，减肥手术组中有96名患者发生肥胖相关癌症，非手术对照组有780名（发病率分别为每1000人-年3.0次事件和4.6次事件）。

减肥手术组和非手术对照组10年主要终点的累积发生率分别为2.9%和4.9%，校正危险比为0.68，组间差异显著。减肥手术组中有21例患者发生癌症相关死亡，非手术对照组中有205例（每1000人-年分别发生0.6次事件和1.2次事件）。减肥手术组10年癌症相关死亡的累积发生率为0.8%，非手术对照组为1.4%，校正危险比为0.52，组间差异显著。

研究结果表明，对于肥胖成年人，与不手术相比，减肥手术与肥胖相关癌症和癌症相关死亡率显著降低相关。

附：英文原文

Title: Association of Bariatric Surgery With Cancer Risk and Mortality in Adults With Obesity

Author: Ali Aminian, Rickesha Wilson, Abbas Al-Kurd, Chao Tu, Alex Milinovich, Matthew Kroh, Raul J. Rosenthal, Stacy A. Brethauer, Philip R. Schauer, Michael W. Kattan, Justin C. Brown, Nathan A. Berger, Jame Abraham, Steven E. Nissen

Issue&Volume: 2022-06-03

Abstract:

Importance  Obesity increases the incidence and mortality from some types of cancer, but it remains uncertain whether intentional weight loss can decrease this risk.

Objective  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 30318 patients. Follow-up ended in February 2021.

Exposures  Bariatric surgery (n=5053), including Roux-en-Y gastric bypass and sleeve gastrectomy, vs nonsurgical care (n=25265).

Main Outcomes and Measures  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.

Results  The study included 30318 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).

Conclusions and Relevance  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.

DOI: 10.1001/jama.2022.9009

Source: https://jamanetwork.com/journals/jama/fullarticle/2793220