Systematic review with meta‐analysis: bariatric surgery reduces the incidence of hepatocellular carcinoma

Summary Background Obesity is a risk factor for non‐alcoholic steatohepatitis (NASH) and increases the risk of several cancer types including cancers of the liver. Bariatric surgery can provide durable weight loss, but little is known about the later development of hepatocellular carcinoma (HCC) aft...

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Published inAlimentary pharmacology & therapeutics Vol. 53; no. 9; pp. 977 - 984
Main Authors Ramai, Daryl, Singh, Jameel, Lester, Janice, Khan, Shahab R., Chandan, Saurabh, Tartaglia, Nicola, Ambrosi, Antonio, Serviddio, Gaetano, Facciorusso, Antonio
Format Journal Article
LanguageEnglish
Published England Wiley Subscription Services, Inc 01.05.2021
Subjects
Bariatric Surgery
Body weight loss
Carcinoma, Hepatocellular - epidemiology
Carcinoma, Hepatocellular - etiology
Carcinoma, Hepatocellular - prevention & control
Gastrointestinal surgery
Hepatocellular carcinoma
Humans
Incidence
Liver cancer
Liver Neoplasms - epidemiology
Liver Neoplasms - etiology
Liver Neoplasms - prevention & control
Meta-analysis
Risk factors
Surgery
Weight Loss
Online AccessGet full text
ISSN0269-2813
1365-2036
1365-2036
DOI10.1111/apt.16335

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Abstract Summary Background Obesity is a risk factor for non‐alcoholic steatohepatitis (NASH) and increases the risk of several cancer types including cancers of the liver. Bariatric surgery can provide durable weight loss, but little is known about the later development of hepatocellular carcinoma (HCC) after surgery. Aim To determine whether bariatric surgery reduces the risk of HCC. Methods We performed a comprehensive literature search of major databases (from inception to November 2020) to identify studies which assess the incidence and risk of HCC following bariatric surgery. Pooled data were assessed using a random‐effects model expressed in terms of odds ratio (OR), incidence rate ratio and 95% confidence interval (CI). Results Nine studies (two s and seven full texts) were included for meta‐analysis which involved 19 514 750 patients (18 423 546 controls and 1 091 204 bariatric patients). Pooled unadjusted odds ratio (OR) was 0.40 (95% CI: 0.28‐0.57) which favoured bariatric surgery, though with high heterogeneity (I2: 79%). Using an adjusted model derived from matched cohorts (five studies) yielded an OR of 0.63 (95% CI: 0.53‐0.75) with moderate heterogeneity (I2: 38%). The pooled rate/1000 person‐years was 0.05 (95% CI: 0.02‐0.07) in bariatric surgery patients and 0.34 (95% CI: 0.20‐0.49) in the control group with an incidence rate ratio of 0.28 (95% CI: 0.18‐0.42). Conclusion Bariatric surgery is associated with a decreased risk of HCC.
AbstractList Obesity is a risk factor for non-alcoholic steatohepatitis (NASH) and increases the risk of several cancer types including cancers of the liver. Bariatric surgery can provide durable weight loss, but little is known about the later development of hepatocellular carcinoma (HCC) after surgery. To determine whether bariatric surgery reduces the risk of HCC. We performed a comprehensive literature search of major databases (from inception to November 2020) to identify studies which assess the incidence and risk of HCC following bariatric surgery. Pooled data were assessed using a random-effects model expressed in terms of odds ratio (OR), incidence rate ratio and 95% confidence interval (CI). Nine studies (two abstracts and seven full texts) were included for meta-analysis which involved 19 514 750 patients (18 423 546 controls and 1 091 204 bariatric patients). Pooled unadjusted odds ratio (OR) was 0.40 (95% CI: 0.28-0.57) which favoured bariatric surgery, though with high heterogeneity (I : 79%). Using an adjusted model derived from matched cohorts (five studies) yielded an OR of 0.63 (95% CI: 0.53-0.75) with moderate heterogeneity (I : 38%). The pooled rate/1000 person-years was 0.05 (95% CI: 0.02-0.07) in bariatric surgery patients and 0.34 (95% CI: 0.20-0.49) in the control group with an incidence rate ratio of 0.28 (95% CI: 0.18-0.42). Bariatric surgery is associated with a decreased risk of HCC.
Summary Background Obesity is a risk factor for non‐alcoholic steatohepatitis (NASH) and increases the risk of several cancer types including cancers of the liver. Bariatric surgery can provide durable weight loss, but little is known about the later development of hepatocellular carcinoma (HCC) after surgery. Aim To determine whether bariatric surgery reduces the risk of HCC. Methods We performed a comprehensive literature search of major databases (from inception to November 2020) to identify studies which assess the incidence and risk of HCC following bariatric surgery. Pooled data were assessed using a random‐effects model expressed in terms of odds ratio (OR), incidence rate ratio and 95% confidence interval (CI). Results Nine studies (two s and seven full texts) were included for meta‐analysis which involved 19 514 750 patients (18 423 546 controls and 1 091 204 bariatric patients). Pooled unadjusted odds ratio (OR) was 0.40 (95% CI: 0.28‐0.57) which favoured bariatric surgery, though with high heterogeneity (I2: 79%). Using an adjusted model derived from matched cohorts (five studies) yielded an OR of 0.63 (95% CI: 0.53‐0.75) with moderate heterogeneity (I2: 38%). The pooled rate/1000 person‐years was 0.05 (95% CI: 0.02‐0.07) in bariatric surgery patients and 0.34 (95% CI: 0.20‐0.49) in the control group with an incidence rate ratio of 0.28 (95% CI: 0.18‐0.42). Conclusion Bariatric surgery is associated with a decreased risk of HCC.
Obesity is a risk factor for non-alcoholic steatohepatitis (NASH) and increases the risk of several cancer types including cancers of the liver. Bariatric surgery can provide durable weight loss, but little is known about the later development of hepatocellular carcinoma (HCC) after surgery.BACKGROUNDObesity is a risk factor for non-alcoholic steatohepatitis (NASH) and increases the risk of several cancer types including cancers of the liver. Bariatric surgery can provide durable weight loss, but little is known about the later development of hepatocellular carcinoma (HCC) after surgery.To determine whether bariatric surgery reduces the risk of HCC.AIMTo determine whether bariatric surgery reduces the risk of HCC.We performed a comprehensive literature search of major databases (from inception to November 2020) to identify studies which assess the incidence and risk of HCC following bariatric surgery. Pooled data were assessed using a random-effects model expressed in terms of odds ratio (OR), incidence rate ratio and 95% confidence interval (CI).METHODSWe performed a comprehensive literature search of major databases (from inception to November 2020) to identify studies which assess the incidence and risk of HCC following bariatric surgery. Pooled data were assessed using a random-effects model expressed in terms of odds ratio (OR), incidence rate ratio and 95% confidence interval (CI).Nine studies (two abstracts and seven full texts) were included for meta-analysis which involved 19 514 750 patients (18 423 546 controls and 1 091 204 bariatric patients). Pooled unadjusted odds ratio (OR) was 0.40 (95% CI: 0.28-0.57) which favoured bariatric surgery, though with high heterogeneity (I2 : 79%). Using an adjusted model derived from matched cohorts (five studies) yielded an OR of 0.63 (95% CI: 0.53-0.75) with moderate heterogeneity (I2 : 38%). The pooled rate/1000 person-years was 0.05 (95% CI: 0.02-0.07) in bariatric surgery patients and 0.34 (95% CI: 0.20-0.49) in the control group with an incidence rate ratio of 0.28 (95% CI: 0.18-0.42).RESULTSNine studies (two abstracts and seven full texts) were included for meta-analysis which involved 19 514 750 patients (18 423 546 controls and 1 091 204 bariatric patients). Pooled unadjusted odds ratio (OR) was 0.40 (95% CI: 0.28-0.57) which favoured bariatric surgery, though with high heterogeneity (I2 : 79%). Using an adjusted model derived from matched cohorts (five studies) yielded an OR of 0.63 (95% CI: 0.53-0.75) with moderate heterogeneity (I2 : 38%). The pooled rate/1000 person-years was 0.05 (95% CI: 0.02-0.07) in bariatric surgery patients and 0.34 (95% CI: 0.20-0.49) in the control group with an incidence rate ratio of 0.28 (95% CI: 0.18-0.42).Bariatric surgery is associated with a decreased risk of HCC.CONCLUSIONBariatric surgery is associated with a decreased risk of HCC.
BackgroundObesity is a risk factor for non‐alcoholic steatohepatitis (NASH) and increases the risk of several cancer types including cancers of the liver. Bariatric surgery can provide durable weight loss, but little is known about the later development of hepatocellular carcinoma (HCC) after surgery.AimTo determine whether bariatric surgery reduces the risk of HCC.MethodsWe performed a comprehensive literature search of major databases (from inception to November 2020) to identify studies which assess the incidence and risk of HCC following bariatric surgery. Pooled data were assessed using a random‐effects model expressed in terms of odds ratio (OR), incidence rate ratio and 95% confidence interval (CI).ResultsNine studies (two abstracts and seven full texts) were included for meta‐analysis which involved 19 514 750 patients (18 423 546 controls and 1 091 204 bariatric patients). Pooled unadjusted odds ratio (OR) was 0.40 (95% CI: 0.28‐0.57) which favoured bariatric surgery, though with high heterogeneity (I2: 79%). Using an adjusted model derived from matched cohorts (five studies) yielded an OR of 0.63 (95% CI: 0.53‐0.75) with moderate heterogeneity (I2: 38%). The pooled rate/1000 person‐years was 0.05 (95% CI: 0.02‐0.07) in bariatric surgery patients and 0.34 (95% CI: 0.20‐0.49) in the control group with an incidence rate ratio of 0.28 (95% CI: 0.18‐0.42).ConclusionBariatric surgery is associated with a decreased risk of HCC.
Author Singh, Jameel
Chandan, Saurabh
Tartaglia, Nicola
Ramai, Daryl
Lester, Janice
Serviddio, Gaetano
Khan, Shahab R.
Ambrosi, Antonio
Facciorusso, Antonio
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  surname: Ramai
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  organization: Mather Hospital, Northwell Health
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  fullname: Lester, Janice
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  givenname: Shahab R.
  surname: Khan
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  surname: Chandan
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  givenname: Antonio
  orcidid: 0000-0002-2107-2156
  surname: Facciorusso
  fullname: Facciorusso, Antonio
  organization: University of Foggia
BackLink https://www.ncbi.nlm.nih.gov/pubmed/33721336$$D View this record in MEDLINE/PubMed
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Notes As part of AP&T's peer‐review process, a technical check of this meta‐analysis was performed by Dr Yuan. The Handling Editor for this article was Dr Stephen Ryder, and it was accepted for publication after full peer‐review.
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  text: May 2021
PublicationDecade 2020
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PublicationTitle Alimentary pharmacology & therapeutics
PublicationTitleAlternate Aliment Pharmacol Ther
PublicationYear 2021
Publisher Wiley Subscription Services, Inc
Publisher_xml – name: Wiley Subscription Services, Inc
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33882170 - Aliment Pharmacol Ther. 2021 May;53(10):1157. doi: 10.1111/apt.16360.
33882165 - Aliment Pharmacol Ther. 2021 May;53(10):1155-1156. doi: 10.1111/apt.16357.
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Snippet Summary Background Obesity is a risk factor for non‐alcoholic steatohepatitis (NASH) and increases the risk of several cancer types including cancers of the...
Obesity is a risk factor for non-alcoholic steatohepatitis (NASH) and increases the risk of several cancer types including cancers of the liver. Bariatric...
BackgroundObesity is a risk factor for non‐alcoholic steatohepatitis (NASH) and increases the risk of several cancer types including cancers of the liver....
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SubjectTerms Bariatric Surgery
Body weight loss
Carcinoma, Hepatocellular - epidemiology
Carcinoma, Hepatocellular - etiology
Carcinoma, Hepatocellular - prevention & control
Gastrointestinal surgery
Hepatocellular carcinoma
Humans
Incidence
Liver cancer
Liver Neoplasms - epidemiology
Liver Neoplasms - etiology
Liver Neoplasms - prevention & control
Meta-analysis
Risk factors
Surgery
Weight Loss
Title Systematic review with meta‐analysis: bariatric surgery reduces the incidence of hepatocellular carcinoma
URI https://onlinelibrary.wiley.com/doi/abs/10.1111%2Fapt.16335
https://www.ncbi.nlm.nih.gov/pubmed/33721336
https://www.proquest.com/docview/2509641595
https://www.proquest.com/docview/2501852566
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