Metabolic and Bariatric Surgery vs. Dietary Counseling in Adults with Severe Obesity: Risk of De Novo Malignancy in a Propensity-Matched Multicentered Real-World Analysis.
Source: PubMed, NCBI / U.S. National Library of Medicine
Obesity is a major driver of cancer incidence and mortality through insulin resistance, chronic inflammation, adipokine dysregulation, and hormonal pathways. While metabolic and bariatric surgery (MBS) is known to reduce weight and improve metabolic dysfunction, its impact on incident malignancy compared with structured non-surgical management remains incompletely defined. We conducted a retrospective cohort study using the TriNetX federated electronic health record network. Adults aged ≥ 18 years with BMI ≥ 35 kg/m² and no prior malignancy were included. Patients undergoing MBS were compared with individuals receiving structured dietary counseling without prior MBS. Propensity score matching incorporated demographic factors, cardiometabolic comorbidities, liver disease, tobacco and alcohol use, hormone exposure, immunosuppressive therapy, and cancer screening encounters. Primary outcomes were incident obesity-related malignancies. Secondary outcomes included non-obesity-related cancers, solid tumors, and hematologic malignancies. Cox proportional hazards models estimated hazard ratios (HR) with 95% confidence intervals (CI) over 5 years of follow-up. After matching, cohorts were well balanced. Obesity-related malignancies occurred in 1.0% of MBS patients versus 1.2% of diet counseling patients (HR 0.775, 95%CI 0.708, 0.847). Significant reductions were observed for breast, colorectal, endometrial, pancreatic, and liver canc
Abstract
Obesity is a major driver of cancer incidence and mortality through insulin resistance, chronic inflammation, adipokine dysregulation, and hormonal pathways. While metabolic and bariatric surgery (MBS) is known to reduce weight and improve metabolic dysfunction, its impact on incident malignancy compared with structured non-surgical management remains incompletely defined. We conducted a retrospective cohort study using the TriNetX federated electronic health record network. Adults aged ≥ 18 years with BMI ≥ 35 kg/m² and no prior malignancy were included. Patients undergoing MBS were compared with individuals receiving structured dietary counseling without prior MBS. Propensity score matching incorporated demographic factors, cardiometabolic comorbidities, liver disease, tobacco and alcohol use, hormone exposure, immunosuppressive therapy, and cancer screening encounters. Primary outcomes were incident obesity-related malignancies. Secondary outcomes included non-obesity-related cancers, solid tumors, and hematologic malignancies. Cox proportional hazards models estimated hazard ratios (HR) with 95% confidence intervals (CI) over 5 years of follow-up. After matching, cohorts were well balanced. Obesity-related malignancies occurred in 1.0% of MBS patients versus 1.2% of diet counseling patients (HR 0.775, 95%CI 0.708, 0.847). Significant reductions were observed for breast, colorectal, endometrial, pancreatic, and liver cancers. Non-obesity-related malignancies occurred in 1.7% versus 1.9% (HR 0.784, 0.732-0.841), with lower lung cancer risk (HR 0.498, 0.377-0.657). Overall solid tumor incidence was 2.2% versus 2.5% (HR 0.801, 0.754, 0.851). Hematologic malignancies occurred in 0.26% versus 0.28% (HR 0.824, 0.689-0.984). In a rigorously matched contemporary cohort, MBS was associated with reduced risk of obesity-related, non-obesity-related, solid, and hematologic malignancies compared with structured dietary counseling.