减重手术对肥胖病人胃癌和食管癌发病率影响的Meta分析

Meta-analysis of gastric and esophageal cancer incidence in obese patients after bariatric surgery

目的 系统性评价减重手术后肥胖病人的胃癌和食管癌发病率的情况。方法 系统性地检索和筛查Cochrane Library,Embase,PubMed,中国知网与万方数据库,根据纳入、排除标准寻找减重手术后胃癌和食管癌发病情况,检索期限为从2000年至2023年7月15日。由2名研究者独立筛选文献,提取文献数据资料和评价纳入研究的方法学质量后,采用RevMan 5.4和STATA16.0软件进行Meta分析。结果 最终纳入7项与胃癌和11项与食管癌发病情况有关的队列研究。Meta分析结果显示:减重手术后胃癌总体发病率与未行手术肥胖病人相当(RR0.59,95%CI 0.31-1.14,P=0.12);而减重手术后食管癌的总体发病率明显低于未行减重手术的肥胖病人(RR 0.61,95%CI 0.37-1.00,P≤0.05)。对减重手术后食管癌发病情况进行亚组分析结果显示,病人中位年龄≤42岁时与食管癌发病率降低相关(RR 0.44,95%CI 0.20-0.99,P=0.05),而中位年龄>42岁则差异无统计学意义(P>0.05);对随访时间进行亚组分析结果显示,减重手术术后随访5年内食管癌发病率显著降低(RR 0.45,95%CI 0.29-0.70,P=0.0003),而术后随访大于5年时,减重手术组与非手术组病人术后的食管癌发病率差异则无统计学意义(P=0.31);对不同手术方式的亚组分析结果显示,不同的手术方式中食管癌发病率的差异均无统计学意义(P>0.05)。结论 与未接受减重手术的肥胖病人相比,接受减重手术后病人的胃癌的发病率与非手术肥胖病人相当,而接受减重手术后食管癌的总体发病率则明显降低。

Objective To systematically evaluate the incidence of gastric and esophageal cancer for obesity patients after weight loss surgery.Methods Cochrane Library,Embase,PubMed,China Knowledge,and Wanfang databases were systematically searched and screened to find studies on the incidence of gastric and esophageal cancers in the population after bariatric surgery based on the inclusion and exclusion criteria,with a search period from 2000 to July 15,2023.Literature was screened independently by 2 investigators,and Meta-analysis was performed using RevMan 5.4 and STATA 16.0 software after extracting data information from the literature and evaluating the methodological quality of the included studies.Results Seven cohort studies on the incidence of gastric cancer and 11 cohort studies related to the incidence of esophageal cancer were finally included.Meta-analysis showed that the incidence of gastric cancer after bariatric surgery was comparable to that of obese patients who did not undergo the surgery(RR 0.59,95%CI 0.31-1.14,P=0.12);whereas,the overall incidence of esophageal cancer after undergoing bariatric surgery was significantly lower than that of the non-operated obese patients(RR 0.61,95%CI 0.37-1.00,P=0.05).Subgroup analysis of esophageal cancer incidence showed that bariatric surgery was associated with a reduced incidence of esophageal cancer when the median age of patients was≤42 years(RR 0.44,95%CI 0.20-0.99,P≤0.05),and stratification according to duration of follow-up revealed that a follow-up period of≤5 years after bariatric surgery was associated with a significantly lower incidence of esophageal cancer (RR 0.45, 95% CI 0.29 -0.70, P= 0.0003), while at a mean follow-up time of >5years, there was no statistically significant difference in postoperative esophageal cancer incidence between patients inthe bariatric surgery group and those in the non- surgical group (P>0.5). Sensitivity analysis showed good stability,reliable conclusions, and no significant publication bias. Conclusion Compared with morbidly obese patients who didnot undergo bariatric surgery, the incidence of gastric cancer in patients who underwent bariatric surgery was comparableto that of nonsurgical obese patients, whereas the overall incidence of esophageal cancer was significantly lower afterundergoing bariatric surgery.