Impact of Bariatric Surgery on Cancer Incidence in Severely Obese Adults

减肥手术对严重肥胖成人癌症发病率的影响

• 批准号: 8631283
• 负责人: DANIEL P SCHAUER
• 金额: $ 73.88万
• 依托单位: UNIVERSITY OF CINCINNATI
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-03-01 至 2017-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8631283
• 关键词: Accounting; Adult; Affect; Age; Bariatrics; Body Weight decreased; Breast; Caring; Characteristics; Clinical Trials; Cohort Studies; Colon; Data; Databases; Electronics; Endometrial; Epidemiology; Ethnic Origin; Gender; Goals; Growth; Health Care Costs; Health Planning; Health Services Research; Heterogeneity; Incidence; Malignant Neoplasms; Mediating; Medical Records; Metabolic; Metabolism; Morbid Obesity; Obesity; Obesity associated cancer; Observational Study; Operative Surgical Procedures; Outcome; Patients; Policies; Population; Population Control; Procedures; Race; Research; Research Infrastructure; Research Methodology; Risk; Risk Factors; Site; Study models; Subgroup; System; Testing; Time; Translating; Weight maintenance regimen; Woman; bariatric surgery; cancer risk; cancer type; cohort; comparative effectiveness; cost; effectiveness research; electronic data; follow-up; health care delivery; high risk; insight; men; neoplasm registry; programs; public health relevance; randomized trial; treatment effect; weight loss intervention

Project Summary/Abstract Severe obesity affects over 15 million U.S. adults and is a well established risk factor for developing some types of cancer. In 2007, obesity was responsible for approximately 50,500 new cases of cancer in women and 34,000 new cases in men. Obesity is a considered a well established risk factor for several types of cancer. However, clinical trials to specifically examine whether intentional weight loss reduces cancer risk have not been done and data from observational studies is sparse and less convincing. Currently, bariatric surgery is the only proven treatment for sustained weight loss in the severely obese patient and is accompanied by immediate alterations of metabolic processes that may also influence cancer growth. Recent observational studies have suggested that bariatric surgery can decrease the incidence of cancer but have either used outdated procedures or have not been adequately controlled. Research is needed to establish whether intentional weight loss can reduce cancer risk to help motivate and guide future research and policy decisions regarding implementation of weight management programs in the US. The goals of this project are 1) estimate the impact of bariatric surgery versus non-surgical treatment on the incidence of cancer (all types) in severely obese patients, 2) explore whether the reduction in risk of cancer after surgery is mediated by weight loss, and 3) determine which patient characteristics are most strongly associated with a reduction in cancer incidence in severely obese patients. This study will utilize data from electronic administrative, medical record databases, and cancer registries from five large, integrated health plans and care delivery systems in the HMO Research Network (HMORN) to estimate the long-term impact of bariatric surgery on cancer outcomes among severely obese patients. We will estimate the incidence of cancer among severely obese (BMI e35) patients who underwent bariatric surgery of any type from 2005-2012 compared to severely obese patients who did not undergo bariatric surgery during the same time period. Main comparisons will use a control population matched by both the propensity for bariatric surgery and the propensity for developing incident cancer. Additional analyses will explore the impact of bariatric surgery on the incidence of cancer (all types and obesity specific types) in severely obese women and the heterogeneity of treatment effects by age, race/ethnicity, and bariatric surgery type. The proposed research will determine whether significant weight loss can reduce cancer incidence using the latest advances in comparative effectiveness research. We will be able to provide insight into potential mechanisms of reducing cancer incidence following surgery by identifying whether the change in risk is mediated by weight loss.

项目总结/摘要 严重肥胖影响超过1500万美国成年人，并且是发展某些疾病的公认风险因素。 癌症的类型。2007年，肥胖症导致大约50，500例女性癌症新发病例 男性新增34,000例肥胖被认为是几种类型糖尿病的公认危险因素。 癌然而，专门研究有意减肥是否会降低癌症风险的临床试验 还没有这样做，来自观察性研究的数据很少，也不太令人信服。目前， 手术是唯一被证实的治疗严重肥胖患者持续减肥的方法， 伴随着代谢过程的直接改变，这也可能影响癌症的生长。最近 观察性研究表明，减肥手术可以降低癌症的发病率， 要么使用过时的程序，要么没有得到充分的控制。需要进行研究以确定 有意减肥是否可以降低癌症风险，以帮助激励和指导未来的研究和政策 关于在美国实施体重管理计划的决定。该项目的目标是 1)估计减肥手术与非手术治疗对癌症发病率的影响（所有类型） 在严重肥胖患者中，2）探索手术后癌症风险的降低是否由以下因素介导： 体重减轻，以及3）确定哪些患者特征与体重减轻最密切相关。 严重肥胖患者的癌症发病率。本研究将利用来自电子管理、医疗 记录数据库和癌症登记处，来自五个大型综合健康计划和护理提供系统， HMO研究网络（HMORN）评估减肥手术对癌症的长期影响 严重肥胖患者的结局。我们将估计严重肥胖者的癌症发病率， (BMI e35）2005-2012年期间接受任何类型减肥手术的患者与重度肥胖患者相比 在同一时期未接受减肥手术的患者。主要比较将使用 对照人群与肥胖手术倾向和发展肥胖症倾向相匹配， 意外癌症其他分析将探讨减肥手术对癌症发病率的影响（所有 类型和肥胖特异性类型）和治疗效果随年龄的异质性， 种族/民族和减肥手术类型。这项拟议中的研究将确定是否显著减肥 可以利用比较有效性研究的最新进展来降低癌症发病率。我们将能够 通过确定以下因素，深入了解降低手术后癌症发病率的潜在机制： 风险的变化是否由体重减轻介导。