Hull York Medical School, York; Centre for Reviews and Dissemination, York.
Department of Paediatric Oncology and Haematology, Leeds General Infirmary, Leeds; Paediatric Dietetic Department, Leeds General Infirmary, Leeds, UK.
Ann Oncol. 2014 Oct;25(10):1919-1929. doi: 10.1093/annonc/mdu106. Epub 2014 Mar 11.
Probiotics are living microorganisms that are generally thought of as being beneficial to the recipient. They have been shown to be effective in people with acute infectious diarrhoea, and cost-effective in antibiotic-associated diarrhoea. Probiotics may have a role in people with cancer, as various cancer treatments often lead to diarrhoea. However, as people with cancer are often immunocompromised, it is important to assess for adverse events (AEs) such as infection, which could potentially be a consequence of deliberate ingestion of living microorganisms.
A systematic review was carried out to collect, analyse and synthesise all available data on the efficacy and safety of probiotics in people with cancer (PROSPERO registration: CRD42012003454). Randomised, controlled trials, identified through screening multiple databases and grey literature, were included for analysing efficacy, while all studies were included for the analysis of safety of probiotics. Primary outcomes were the reduction in duration, severity and incidence of antibiotic-associated diarrhoea and chemotherapy-associated diarrhoea, and AEs, especially probiotic-associated infection. Where possible, data were combined for meta-analysis by a random-effects model, assessing causes of heterogeneity, including differences in strains, dosage and patient characteristics.
Eleven studies (N = 1557 participants) were included for assessing efficacy. Results show that probiotics may reduce the severity and frequency of diarrhoea in patients with cancer and may reduce the requirement for anti-diarrhoeal medication, but more studies are needed to assess the true effect. For example comparing probiotic use to control 25 groups on effect on Common Toxicity Criteria ≥2 grade diarrhoea, odds ratio (OR) = 0.32 [95% confidence interval (CI) of 0.13-0.79; P = 0.01]. Seventeen studies (N = 1530) were included in the safety analysis. Five case reports showed probiotic-related bacteraemia/fungaemia/positive blood cultures.
Probiotics may be a rare cause of sepsis. Further evidence needs to be collated to determine whether probiotics provide a significant overall benefit for people with cancer.
益生菌是通常被认为对接受者有益的活体微生物。它们已被证明对急性感染性腹泻患者有效，并且在抗生素相关性腹泻方面具有成本效益。益生菌可能在癌症患者中发挥作用，因为各种癌症治疗常常导致腹泻。然而，由于癌症患者通常免疫功能低下，因此评估不良反应（AE）非常重要，例如感染，这可能是故意摄入活体微生物的后果。
进行了系统评价，以收集、分析和综合所有关于益生菌在癌症患者中的疗效和安全性的可用数据（PROSPERO 注册：CRD42012003454）。通过筛选多个数据库和灰色文献确定了随机对照试验，以分析疗效，同时所有研究均包括益生菌安全性分析。主要结局是减少抗生素相关性腹泻和化疗相关性腹泻的持续时间、严重程度和发生率，以及 AE，特别是益生菌相关性感染。在可能的情况下，通过随机效应模型对数据进行合并进行荟萃分析，评估异质性的原因，包括菌株、剂量和患者特征的差异。
有 11 项研究（N = 1557 名参与者）纳入评估疗效。结果表明，益生菌可能减少癌症患者腹泻的严重程度和频率，并可能减少对止泻药物的需求，但需要更多研究来评估真实效果。例如，将益生菌使用与对照（25 组）比较对常见毒性标准≥2 级腹泻的影响，比值比（OR）= 0.32 [95%置信区间（CI）0.13-0.79；P = 0.01]。安全性分析共纳入 17 项研究（N = 1530）。5 例病例报告显示益生菌相关性菌血症/真菌血症/阳性血培养。
益生菌可能是败血症的罕见原因。需要进一步收集证据来确定益生菌是否为癌症患者提供显著的整体益处。
