Hendifar Andrew, Akinsola Rasaq, Muranaka Hayato, Osipov Arsen, Thomassian Shant, Moshayedi Natalie, Yang Julianne, Jacobs Jonathan, Devkota Suzanne, Bhowmick Neil, Gong Jun
Department of Medicine, Division of Hematology and Oncology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States.
The Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, University of California, Los Angeles, CA 90095, United States.
World J Gastrointest Oncol. 2022 Jul 15;14(7):1218-1226. doi: 10.4251/wjgo.v14.i7.1218.
Nearly 80% of patients with pancreatic ductal adenocarcinoma (PDAC) develop cachexia along their disease course. Cachexia is characterized by progressive weight loss, muscle wasting, and systemic inflammation and has been linked to poorer outcomes and impairments in quality of life. Management of PDAC cachexia has historically involved a multidisciplinary effort comprised of nutritional support, pancreatic enzyme replacement therapy, and/or pharmacologic interventions. Despite current interventions to mitigate PDAC cachexia, a significant proportion of patients continue to die from complications associated with cachexia underscoring the need for novel insights and treatments for this syndrome. We highlight the feasibility and effectiveness of a recent enteral feeding prospective trial at our institution to improve cachexia outcomes in patients with advanced PDAC. Additionally, we were among the first to characterize the stool microbiome composition in patients with advanced PDAC receiving enteral feeding for the treatment of cachexia. Novel insights into the relationship between enteral nutritional support, cachexia, and the gut microbiome are presented. These promising results are discussed in the context of a potential ability to modulate the stool microbiome as a new interventional strategy to mitigate PDAC cachexia.
近80%的胰腺导管腺癌（PDAC）患者在病程中会出现恶病质。恶病质的特征是进行性体重减轻、肌肉消耗和全身炎症，并且与较差的预后及生活质量受损有关。PDAC恶病质的管理历来需要多学科协作，包括营养支持、胰酶替代疗法和/或药物干预。尽管目前采取了减轻PDAC恶病质的干预措施，但仍有相当一部分患者死于与恶病质相关的并发症，这凸显了对该综合征进行新的深入研究和治疗的必要性。我们强调了我们机构最近进行的一项肠内喂养前瞻性试验在改善晚期PDAC患者恶病质结局方面的可行性和有效性。此外，我们是首批对接受肠内喂养治疗恶病质的晚期PDAC患者的粪便微生物群组成进行表征的研究团队之一。本文介绍了关于肠内营养支持、恶病质和肠道微生物群之间关系的新见解。在调节粪便微生物群作为减轻PDAC恶病质的一种新干预策略的潜在能力的背景下，对这些有前景的结果进行了讨论。
