益生菌治疗对新辅助化疗治疗食管癌期间菌血症的影响：一项随机对照试验。

Impact of synbiotics treatment on bacteremia induced during neoadjuvant chemotherapy for esophageal cancer: A randomised controlled trial.

机构信息

Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.

Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan; Division of Perioperative Medicine, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.

出版信息

Clin Nutr. 2021 Dec;40(12):5781-5791. doi: 10.1016/j.clnu.2021.10.004. Epub 2021 Oct 13.

DOI:10.1016/j.clnu.2021.10.004

PMID:34775221

Abstract

BACKGROUND & AIMS: To elucidate the impact of synbiotics on bacterial translocation and subsequent bacteremia during neoadjuvant chemotherapy for esophageal cancer.

METHODS

Patients requiring neoadjuvant chemotherapy for esophageal cancer were randomized to receive synbiotics (synbiotics group) or no synbiotics (control group) during chemotherapy. Blood and fecal samples were taken before and after every chemotherapy cycle, and 1 day before surgery. Mesenteric lymph nodes (MLNs) were harvested at laparotomy (MLN-1) and after resection of the tumor (MLN-2). Bacteria in each sample were detected. Fecal microbiota and organic acid concentrations were also determined. The primary endpoint was the detection of bacteria in the blood samples, as well as the incidence of side effects during chemotherapy. The secondary endpoint was the detection rate of bacteria in the MLN samples collected during surgery.

RESULTS

The study recruited a total of 42 patients (22 in the control group, 20 in the synbiotics group). Bacteria were detected in 16 of 101 blood samples in the control group, whereas those were detected only 2 of 100 blood samples in the synbiotics group (p < 0.001) during neoadjuvant chemotherapy. Additionally, bacteria were detected in 12 of 34 MLN samples in the control group, whereas no bacteria were detected in 38 MLN samples in the synbiotics group (p < 0.001). Suppression of bacterial translocation was at least partly associated with an increased fecal acetic acid concentration as well as a lowered fecal pH by synbiotics. The incidence rate of grade 3 gastrointestinal toxicity during chemotherapy was lower in the synbiotics group compared to the control group (8/22 vs. 1/20, p = 0.022).

CONCLUSIONS

Neoadjuvant chemotherapy for esophageal cancer may induce bacterial translocation and subsequent bacteremia, which can be prevented by synbiotics administration.

TRIAL REGISTRATION

The University Hospital Medical Information Network (http://www.umin.ac.jp; registration number ID 000007651).

摘要

背景与目的

阐明合生元对食管癌新辅助化疗期间细菌易位和随后菌血症的影响。

方法

需要新辅助化疗的食管癌患者被随机分为化疗期间接受合生元（合生元组）或不接受合生元（对照组）。在每个化疗周期前后以及手术前 1 天采集血液和粪便样本。剖腹术时采集肠系膜淋巴结（MLN-1）和肿瘤切除后采集 MLN-2。检测每个样本中的细菌。还测定粪便微生物群和有机酸浓度。主要终点是检测血液样本中的细菌以及化疗期间的副作用发生率。次要终点是检测手术期间采集的 MLN 样本中的细菌检出率。

结果

该研究共招募了 42 名患者（对照组 22 名，合生元组 20 名）。在新辅助化疗期间，对照组 101 份血样中有 16 份检出细菌，而合生元组 100 份血样中仅 2 份检出细菌（p<0.001）。此外，对照组 34 份 MLN 样本中有 12 份检出细菌，而合生元组 38 份 MLN 样本中未检出细菌（p<0.001）。合生元对细菌易位的抑制作用至少部分与粪便乙酸浓度升高和粪便 pH 值降低有关。与对照组相比，合生元组化疗期间 3 级胃肠道毒性的发生率较低（8/22 与 1/20，p=0.022）。