Ali Aminian1, Rickesha Wilson1, Abbas Al-Kurd1, Chao Tu2, Alex Milinovich2, Matthew Kroh1, Raul J Rosenthal3, Stacy A Brethauer4, Philip R Schauer5, Michael W Kattan2, Justin C Brown6, Nathan A Berger7, Jame Abraham8, Steven E Nissen9. 1. Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Cleveland, Ohio. 2. Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio. 3. Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic Florida, Weston. 4. Department of Surgery, Ohio State University Wexner Medical Center, Columbus. 5. Metamor Institute, Pennington Biomedical Research Center, Louisiana State University, Baton Rouge. 6. Cancer Metabolism Program, Pennington Biomedical Research Center, Louisiana State University, Baton Rouge. 7. Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio. 8. Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio. 9. Cleveland Clinic Coordinating Center for Clinical Research, Cleveland, Ohio.
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 30 318 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 = 25 265). 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 30 318 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.
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 30 318 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 = 25 265). 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 30 318 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.
Authors: Deepak L Bhatt; Ali Aminian; Sangeeta R Kashyap; John P Kirwan; Kathy Wolski; Stacy A Brethauer; Stanley L Hazen; Steven E Nissen; Philip R Schauer Journal: J Am Coll Cardiol Date: 2019-07-16 Impact factor: 24.094
Authors: Andrea M Stroud; Elizabeth N Dewey; Farah A Husain; Jared M Fischer; Anita P Courcoulas; David R Flum; James E Mitchell; Walter J Pories; Jonathan Q Purnell; Bruce M Wolfe Journal: Surg Obes Relat Dis Date: 2020-04-19 Impact factor: 4.734
Authors: Daniel P Schauer; Heather Spencer Feigelson; Corinna Koebnick; Bette Caan; Sheila Weinmann; Anthony C Leonard; J David Powers; Panduranga R Yenumula; David E Arterburn Journal: Ann Surg Date: 2019-01 Impact factor: 12.969
Authors: Michelle L MacKintosh; Abigail E Derbyshire; Rhona J McVey; James Bolton; Mahshid Nickkho-Amiry; Catherine L Higgins; Martyna Kamieniorz; Philip W Pemberton; Bilal H Kirmani; Babur Ahmed; Akheel A Syed; Basil J Ammori; Andrew G Renehan; Henry C Kitchener; Emma J Crosbie Journal: Int J Cancer Date: 2018-11-20 Impact factor: 7.396
Authors: Robert C Ross; Yetunde M Akinde; Philip R Schauer; Carel W le Roux; Donal Brennan; Amelia M Jernigan; Marco Bueter; Vance L Albaugh Journal: Front Surg Date: 2022-08-31
Authors: Margaret S Bohm; Laura M Sipe; Madeline E Pye; Matthew J Davis; Joseph F Pierre; Liza Makowski Journal: Cancer Metastasis Rev Date: 2022-07-23 Impact factor: 9.237
Authors: Laura M Sipe; Mehdi Chaib; Emily B Korba; Heejoon Jo; Mary Camille Lovely; Brittany R Counts; Ubaid Tanveer; Jeremiah R Holt; Jared C Clements; Neena A John; Deidre Daria; Tony N Marion; Margaret S Bohm; Radhika Sekhri; Ajeeth K Pingili; Bin Teng; James A Carson; D Neil Hayes; Matthew J Davis; Katherine L Cook; Joseph F Pierre; Liza Makowski Journal: Elife Date: 2022-07-01 Impact factor: 8.713
Authors: Eleonora Feletto; Ankur Kohar; David Mizrahi; Paul Grogan; Julia Steinberg; Clare Hughes; Wendy L Watson; Karen Canfell; Xue Qin Yu Journal: Lancet Reg Health West Pac Date: 2022-09-06