Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, 359-8513, Japan.
Cancer Metastasis Rev. 2021 Mar;40(1):285-296. doi: 10.1007/s10555-020-09945-z. Epub 2021 Jan 3.
There is increasing evidence that postoperative infectious complications (PICs) are associated with poor prognosis after potentially curative surgery. However, the role that PICs play in tumor development remains unclear. In this article, we reviewed the literature for novel insights on the mechanisms of cancer progression associated with PICs. The Medline and EMBASE databases were searched for publications regarding the role of suppression of antitumor immunity by PIC in tumor progression and selected 916 manuscripts were selected for this review. In addition, a summary of the authors' own experimental data from this field was set in the context of current knowledge regarding cancer progression under septic conditions. Initially, sepsis/microbial infection dramatically activates the systemic immune system with increases in pro-inflammatory mediators, which results in the development of systemic inflammatory response syndrome; however, when sepsis persists in septic patients, a shift toward an anti-inflammatory immunosuppressive state, characterized by macrophage deactivation, reduced antigen presentation, T cell anergy, and a shift in the T helper cell pattern to a predominantly TH2-type response, occurs. Thus, various cytokine reactions and the immune status dynamically change during microbial infection, including PIC. We proposed three possible mechanisms for the tumor progression associated with PIC: first, a mechanism in which microbes and/or microbial PAMPs may be directly involved in cancer growth; second, a mechanism in which factors released from immunocompetent cells during infections may affect tumor progression; and third, a mechanism in which factors suppress host tumor immunity during infections, which may result in tumor progression. A more detailed understanding by surgeons of the immunological features in cancer patients with PIC can subsequently open new avenues for improving unfavorable long-term oncological outcomes associated with PICs.
越来越多的证据表明，术后感染并发症（PICs）与潜在治愈性手术后的不良预后有关。然而，PIC 在肿瘤发展中的作用尚不清楚。在本文中，我们回顾了文献中关于与 PIC 相关的肿瘤进展相关的抗肿瘤免疫抑制机制的新见解。在 Medline 和 EMBASE 数据库中搜索了关于 PIC 在肿瘤进展中抑制抗肿瘤免疫的作用的出版物，并选择了 916 篇论文进行了综述。此外，还根据该领域作者自己的实验数据，概述了在脓毒症条件下癌症进展的现有知识背景下。最初，脓毒症/微生物感染会使全身免疫系统急剧激活，导致促炎介质增加，从而导致全身炎症反应综合征的发生；然而，当脓毒症患者的脓毒症持续存在时，会向抗炎免疫抑制状态转变，其特征为巨噬细胞失活、抗原呈递减少、T 细胞无能以及 T 辅助细胞模式向以 TH2 型反应为主的转变。因此，在微生物感染过程中，包括 PIC，各种细胞因子反应和免疫状态都会发生动态变化。我们提出了与 PIC 相关的肿瘤进展的三种可能机制：第一，微生物和/或微生物 PAMP 可能直接参与肿瘤生长的机制；第二，感染期间免疫细胞释放的因子可能影响肿瘤进展的机制；第三，感染期间宿主抗肿瘤免疫被抑制的机制，这可能导致肿瘤进展。外科医生对患有 PIC 的癌症患者的免疫学特征有更详细的了解，随后可能会为改善与 PIC 相关的不良长期肿瘤学结局开辟新途径。
