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围手术期补充益生菌对新辅助化疗后接受腹腔镜或机器人根治性胃切除术患者短期临床结局的影响:一项多中心随机对照试验的研究方案(GISSG2023 - 01研究)

Effect of perioperative probiotic supplements on the short-term clinical outcomes of patients undergoing laparoscopic or robotic radical gastrectomy after neoadjuvant chemotherapy: Study protocol for a multicenter randomized controlled trial (GISSG2023 - 01 Study).

作者信息

Liu Gan, Cao Shougen, Liu Xiaodong, Tian Yulong, Yu Wenbin, Chai Jie, Li Leping, Wang Xixun, Chu Xianqun, Duan Quanhong, Qu Jianjun, Wang Hao, Zhang Huanhu, Wang Xinjian, Hui Xizeng, Yang Daogui, Zhou Shaofei, Ding Yinlu, Wang Hongbo, Zhou Fengqiang, Hu Baoguang, Guo Peiming, Jiang Lixin, Zhang Guangyong, Pan Qiang, Zhou Xiaobin, Zhou Yanbing

机构信息

Department of Gastrointestinal Surgery, the Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao, China.

Qilu Hospital of Shandong University, Jinan, China.

出版信息

BMC Cancer. 2025 Apr 25;25(1):776. doi: 10.1186/s12885-025-14115-x.


DOI:10.1186/s12885-025-14115-x
PMID:40281451
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12023430/
Abstract

BACKGROUND: Gastric cancer is a common malignant tumor, and radical gastrectomy can markedly improve the prognosis of gastric cancer patients. However, some patients are diagnosed with advanced gastric cancer before receiving any antitumor therapy and need to receive neoadjuvant chemotherapy (NACT). Previous studies have shown that NACT may cause gut barrier dysfunction and intestinal dysbacteriosis which may further lead to infections. Probiotics have the potential to reduce postoperative infections and improve short-term outcomes after abdominal surgery; however, no large-sample, multicenter, randomized clinical trials have been conducted to explore the effectiveness of probiotics in gastric cancer patients receiving NACT. So we proposed a hypothesis that probiotics can improve short-term outcomes after minimally invasive radical gastrectomy in gastric cancer patients receiving NACT and designed this multicenter randomized controlled trial with the objective to verify this hypothesis. METHODS/DESIGN: The GISSG 2023-01 study will be a prospective, open-label, multicenter RCT to verify whether perioperatively probiotic supplementation (begin from the end of the last cycle of NACT to postoperative day 7 or the discharge day) can reduce postoperative infections and improve recovery of gastrointestinal function and other short-term outcomes after minimally invasive radical gastrectomy in gastric cancer patients receiving NACT. A total of 318 patients who meet the inclusion criteria will be enrolled in this study and randomly divided into two groups in a 1:1 ratio: the probiotic group (n = 159) and the control group (n = 159). The participants in the probiotic group will receive perioperative probiotic supplementation, and those in the control group will receive blank control management. The other perioperative management protocols will be the same between the two groups. The primary outcome is postoperative infection compared between the two groups, and the secondary outcomes are postoperative recovery of gastrointestinal function, quality of life, laboratory parameters of systemic inflammation and other short-term outcomes. DISCUSSION: The results of this RCT should clarify whether perioperative probiotic supplementation would reduce postoperative infection, promote recovery of gastrointestinal function, reduce laboratory parameters of systemic inflammation and improve symptoms and quality of life after minimally invasive radical gastrectomy in gastric cancer patients receiving NACT. It is hoped that our data will provide evidence that probiotic supplementation improves short-term outcomes in gastric cancer patients receiving NACT. TRIAL REGISTRATION: This trial has been registered on https://clinicaltrials.gov/(NCT05901779 ).

摘要

背景:胃癌是一种常见的恶性肿瘤,根治性胃切除术可显著改善胃癌患者的预后。然而,一些患者在接受任何抗肿瘤治疗之前就被诊断为晚期胃癌,需要接受新辅助化疗(NACT)。既往研究表明,NACT可能导致肠道屏障功能障碍和肠道菌群失调,进而可能导致感染。益生菌有可能减少腹部手术后的感染并改善短期预后;然而,尚未进行大样本、多中心、随机临床试验来探讨益生菌在接受NACT的胃癌患者中的有效性。因此,我们提出了一个假设,即益生菌可以改善接受NACT的胃癌患者在微创根治性胃切除术后的短期预后,并设计了这项多中心随机对照试验以验证这一假设。 方法/设计:GISSG 2023-01研究将是一项前瞻性、开放标签、多中心随机对照试验,以验证围手术期补充益生菌(从NACT最后一个周期结束至术后第7天或出院日)是否能减少接受NACT的胃癌患者在微创根治性胃切除术后的感染,并改善胃肠功能恢复及其他短期预后。共有318例符合纳入标准的患者将被纳入本研究,并按1:1的比例随机分为两组:益生菌组(n = 159)和对照组(n = 159)。益生菌组的参与者将接受围手术期益生菌补充,对照组的参与者将接受空白对照管理。两组之间的其他围手术期管理方案将相同。主要结局是两组之间比较的术后感染,次要结局是术后胃肠功能恢复、生活质量、全身炎症的实验室参数及其他短期结局。 讨论:这项随机对照试验的结果应能阐明围手术期补充益生菌是否会减少接受NACT的胃癌患者在微创根治性胃切除术后的感染,促进胃肠功能恢复,降低全身炎症的实验室参数,并改善症状和生活质量。希望我们的数据将提供证据表明补充益生菌可改善接受NACT的胃癌患者的短期预后。 试验注册:本试验已在https://clinicaltrials.gov/(NCT05901779)上注册。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dfcf/12023430/5ad2711cce4c/12885_2025_14115_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dfcf/12023430/5fe7aafe4e9d/12885_2025_14115_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dfcf/12023430/5ad2711cce4c/12885_2025_14115_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dfcf/12023430/5fe7aafe4e9d/12885_2025_14115_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dfcf/12023430/5ad2711cce4c/12885_2025_14115_Fig2_HTML.jpg

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本文引用的文献

[1]
Multimodal prehabilitation to improve functional abilities and reduce the chronic inflammatory response of frail elderly patients with gastric cancer: A prospective cohort study.

Eur J Surg Oncol. 2025-3

[2]
Benefits and harm of probiotics and synbiotics in adult critically ill patients. A systematic review and meta-analysis of randomized controlled trials with trial sequential analysis.

Clin Nutr. 2023-4

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Nutrition. 2022-4

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