Association between bariatric surgery and risks of cancer among Chinese patients with type 2 diabetes mellitus: A retrospective cohort study
减重手术与患癌风险的关系:一项基于中国2型糖尿病人群的回顾性队列研究
Yihui Wei, Simon K. H. Wong, and Tingting Wu contributed equally to this work.
Abstract
enBackground
To examine risks of cancers, obesity-related cancers (eg, cancers in digestive organs, breast, ovary, kidney, thyroid, and myeloma), cancer-related mortality, and all-cause mortality in patients with type 2 diabetes mellitus (T2DM) and obesity who underwent bariatric surgery.
Methods
A retrospective cohort of 1944 T2DM patients with obesity (345 bariatric surgery patients and 1599 matched controls) who were free of cancer from 2006 to 2017 was assembled. One-to-five propensity score matching followed by propensity score trimming was used to balance baseline covariates.
Results
During a mean follow-up period of 37 months, there are risks that in 3.2%, 1.4%, 0.9%, and 3.2% of bariatric patients cancer, obesity-related cancer, cancer-related mortality, and all-cause mortality, respectively, would occur. Surgical patients were found to have reduced incidence rates (IRs) of obesity-related cancer (0.531/100 person-years, 95% confidence interval [CI]: 0.172-1.238/100 person-years) and cancer of breast and genital organs (0.394/100 person-years, 95% CI: 0.048-1.424/100 person-years) than matched control patients whose IRs for obesity-related cancer and cancer of breast and genital organs were 0.627/100 person-years (95% CI: 0.426-0.889/100 person-years) and 0.521/100 person-years (95% CI: 0.277-0.891/100 person-years), respectively. Patients in the surgical group had a significant reduction in risk of all-cause mortality (hazard ratio [HR] = 0.508, P = .041). Effects of bariatric surgery on any cancers (HR = 1.254, P = .510), obesity-related cancers (HR = 0.843, P = .724), and cancer mortality (HR = 1.304, P = .694) were not significant.
Conclusions
Bariatric surgery was not associated with risks of overall cancer, obesity-related cancer, and cancer mortality among T2DM patients with obesity at 3 years.
摘要
zh目标
研究2型糖尿病患者在减重手术后发生癌症, 肥胖相关癌症(例如, 消化器官癌, 乳癌, 卵巢癌, 肾癌, 甲状腺癌和骨髓瘤), 癌症死亡和全因死亡的风险。
方法
本项研究是一项回顾性队列研究, 共纳入了1944名在2006年至2017年期间未曾罹患过癌症的2型糖尿病合并肥胖症患者。其中, 手术组为345名接受过减重手术的患者, 对照组为1599名未接受过减重手术的患者。两组患者的基线水平采用了一比五倾向评分匹配以及倾向评分修剪进行平衡。
结果
经过平均37个月的跟踪随访, 手术组发生癌症, 肥胖相关癌症, 癌症死亡与全因死亡的风险分别为3.2%, 1.4%, 0.9%和3.2%。手术组肥胖相关癌症的发病率以及乳癌或生殖器癌的发病率比对照组低。两组肥胖相关癌症的发病率分别为0.531/100 人年 (95% 置信区间:0.172-1.238/100 人年)和0.627/100 人年(95% 置信区间:0.426-0.889/100人年)。两组乳癌或生殖器癌的发病率分别为0.394/100人年(95% 置信区间:0.048-1.424/100 人年) 和0.521/100 人年(95% 置信区间:0.277-0.891/100人年)。手术组发生全因死亡的风险显著低于对照组, 风险比为 0.508(P=0.041)。然而, 手术组与对照组发生癌症, 肥胖相关癌症或癌症死亡的风险无显著差异, 两组风险比分别为1.254(P=0.510), 0.843(P=0.724)和1.304(P =0.694)。
结论
减重手术术后三年内并不会增加2型糖尿病合并肥胖症患者的癌症, 肥胖相关癌症以及癌症死亡风险。
