Canadian College of Naturopathic Medicine, Toronto, ON, Canada.
University of Technology Sydney, Ultimo, Australia.
Integr Cancer Ther. 2021 Jan-Dec;20:1534735421997551. doi: 10.1177/1534735421997551.
Branched-chain amino acids (BCAAs; leucine, isoleucine, and valine) are essential amino acids involved in immune responses, and may have roles in protein malnutrition and sarcopenia. Furthermore, certain liver diseases have been associated with a decreased Fischer's ratio (BCAAs to aromatic amino acids; phenylalanine, tyrosine, and tryptophan). We aimed to evaluate the safety and efficacy of BCAAs use in patients with cancer undergoing surgery.
MEDLINE, Embase, and CENTRAL were searched (inception to July 24, 2020) for randomized controlled trials (RCTs) and comparative observational studies in English evaluating BCAAs (alone or in combinations) during the oncological peri-operative period. Study selection, data extraction, and quality appraisal were done in duplicate. RCT risk-of-bias was appraised using Cochrane Risk-of-Bias tool, and observational studies' quality assessment was conducted with Newcastle-Ottawa Scale. Meta-analyses were conducted when appropriate.
20 articles were included comprising 13 RCTs and 6 observational cohort studies in 7 reports and 2019 total participants overall. Among 13 RCTs, 77% involved liver cancer. Methodological study quality scored substantial risk-of-bias across most RCTs. Meta-analysis of RCTs found a 38% decreased risk of post-operative infections in BCAAs group compared to controls (RR = 0.62; 95% CI = 0.44 to 0.87; = .006; number of RCTs, = 6; total sample size, N = 389; = 0%). BCAAs were also found to be beneficial for ascites (RR = 0.55; 95% CI = 0.35 to 0.86; = .008; = 4; N = 296; = 0%), body weight (MD = 3.24 kg; 95% CI = 0.44 to 6.04; = .02; = 3; N = 196; = 24%), and hospitalization length (MD = -2.07 days; 95% CI = -3.97 to -0.17; = .03; = 5; N = 362; = 59%). No differences were found between BCAAs and controls for mortality, recurrence, other post-operative complications (liver failure, edema, pleural effusion), blood loss, quality of life, ammonia level, and prothrombin time. No serious adverse events were related to BCAAs; however, serious adverse events were reported due to intravenous catheters. No safety concerns from observational studies were identified.
Branched-chain amino acids during the oncological surgical period demonstrated promise in reducing important post-operative morbidity from infections and ascites compared to controls. Blinded, placebo-controlled confirmatory trials of higher methodological quality are warranted, especially using oral, short-term BCAAs-enriched supplements within the context of recent ERAS programs.
CRD42018086168.
支链氨基酸（BCAA；亮氨酸、异亮氨酸和缬氨酸）是参与免疫反应的必需氨基酸，可能在蛋白质营养不良和肌肉减少症中发挥作用。此外，某些肝脏疾病与 Fischer 比（BCAA 与芳香族氨基酸；苯丙氨酸、酪氨酸和色氨酸）降低有关。我们旨在评估癌症患者在手术期间使用支链氨基酸的安全性和疗效。
检索 MEDLINE、Embase 和 CENTRAL 数据库（从成立到 2020 年 7 月 24 日），以评估在肿瘤围手术期使用支链氨基酸（单独或联合使用）的随机对照试验（RCT）和对照观察性研究。采用双人独立研究选择、数据提取和质量评估。采用 Cochrane 风险偏倚工具评估 RCT 的风险偏倚，采用 Newcastle-Ottawa 量表评估观察性研究的质量评估。当合适时进行荟萃分析。
共纳入 20 篇文章，包括 7 篇报告中的 13 项 RCT 和 6 项观察性队列研究，共涉及 2019 名参与者。在 13 项 RCT 中，77%的研究涉及肝癌。大多数 RCT 的方法学研究质量评分存在较大的风险偏倚。RCT 的荟萃分析发现，与对照组相比，支链氨基酸组术后感染的风险降低了 38%（RR=0.62；95%CI=0.44 至 0.87；=0.006；RCT 数量，=6；总样本量，N=389；=0%）。还发现支链氨基酸对腹水（RR=0.55；95%CI=0.35 至 0.86；=0.008；=4；N=296；=0%）、体重（MD=3.24kg；95%CI=0.44 至 6.04；=0.02；=3；N=196；=24%）和住院时间（MD=-2.07 天；95%CI=-3.97 至-0.17；=0.03；=5；N=362；=59%）有益。与对照组相比，支链氨基酸组与死亡率、复发、其他术后并发症（肝衰竭、水肿、胸腔积液）、失血量、生活质量、血氨水平和凝血酶原时间无差异。没有发现与支链氨基酸相关的严重不良事件；然而，由于静脉导管，报告了严重的不良事件。没有发现观察性研究的安全性问题。
与对照组相比，肿瘤手术期间使用支链氨基酸在降低感染和腹水等重要术后发病率方面显示出了一定的前景。需要进行盲法、安慰剂对照的高质量确认性试验，特别是在最近的 ERAS 方案中使用口服、短期富含支链氨基酸的补充剂。
PROSPERO 注册号：CRD42018086168。
