结直肠癌切除术后黏膜相关癌微生物与吻合口漏。
Mucosal cancer-associated microbes and anastomotic leakage after resection of colorectal carcinoma.
机构信息
Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan; Department of Surgery, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan.
Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan.
出版信息
Surg Oncol. 2020 Mar;32:63-68. doi: 10.1016/j.suronc.2019.11.005. Epub 2019 Nov 18.
BACKGROUND
Clinical and experimental evidence suggests that colorectal mucosal microbiota changes during colorectal carcinogenesis and may impair colorectal anastomotic wound healing. Thus, we hypothesized that amounts of colorectal cancer-associated microbes in colorectal tissue might be associated with anastomotic leakage after resection for colorectal carcinoma.
METHODS
We analyzed 256 fresh frozen tissues of colorectal cancer from patients who underwent elective colorectal resection and anastomosis. Amounts of colorectal cancer-associated microbes, including Fusobacterium nucleatum, Escherichia coli possessing the polyketide synthase (pks) gene cluster, Enterococcus faecalis, and Bifidobacterium genus, in colorectal cancer tissues were measured by quantitative polymerase chain reaction assay; we equally dichotomized positive cases (high versus low). Multivariable logistic regression analysis was conducted to assess associations of these microbes with anastomotic leakage, adjusting for patient and tumor characteristics, and surgery-related factors.
RESULTS
Fusobacterium nucleatum, pks-positive Escherichia coli, Enterococcus faecalis, and Bifidobacterium genus were detected in colorectal carcinoma tissue in 140 (54%), 94 (36%), 193 (75%), and 89 (35%) of 256 cases, respectively. Compared with Bifidobacterium genus-negative cases, Bifidobacterium genus-high cases were associated with an increased risk of anastomotic leakage (multivariable odds ratio, 3.96; 95% confidence interval, 1.50 to 10.51; P = 0.004). The association of Fusobacterium nucleatum, pks-positive Escherichia coli, or Enterococcus faecalis with anastomotic leakage was not statistically significant.
CONCLUSIONS
The amount of Bifidobacterium genus in colorectal tissue is associated with an increased risk of anastomotic leakage after resection for colorectal cancer. These findings need to be validated to target gastrointestinal microflora for the prevention of anastomotic leakage after colorectal resection.
背景
临床和实验证据表明，结直肠黏膜微生物群在结直肠癌发生过程中发生变化，并可能损害结直肠吻合口愈合。因此，我们假设结直肠组织中结直肠癌相关微生物的数量可能与结直肠癌切除术后吻合口漏的发生有关。
方法
我们分析了 256 例接受择期结直肠切除和吻合术的结直肠癌患者的 256 份新鲜冷冻结直肠组织。通过定量聚合酶链反应检测结直肠癌细胞中结直肠癌相关微生物的含量，包括具核梭杆菌、携带聚酮合酶（pks）基因簇的大肠杆菌、粪肠球菌和双歧杆菌属；将阳性病例（高与低）均等二分。采用多变量逻辑回归分析评估这些微生物与吻合口漏的相关性，调整患者和肿瘤特征以及与手术相关的因素。
结果
140 例（54%）、94 例（36%）、193 例（75%）和 89 例（35%）的结直肠癌组织中分别检测到具核梭杆菌、pks 阳性大肠杆菌、粪肠球菌和双歧杆菌属。与双歧杆菌属阴性病例相比，双歧杆菌属阳性病例吻合口漏的风险增加（多变量优势比，3.96；95%置信区间，1.50 至 10.51；P=0.004）。具核梭杆菌、pks 阳性大肠杆菌或粪肠球菌与吻合口漏的相关性无统计学意义。
结论
结直肠组织中双歧杆菌属的数量与结直肠癌切除术后吻合口漏的风险增加有关。这些发现需要进一步验证，以便针对胃肠道微生物群预防结直肠切除术后吻合口漏。
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