Impact of synbiotics treatment on bacteremia induced during neoadjuvant chemotherapy for esophageal cancer: A randomised controlled trial
Impact of synbiotics treatment on bacteremia induced during neoadjuvant chemotherapy for esophageal cancer: A randomised controlled trial
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DOI：
10.1016/j.clnu.2021.10.004
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发表时间：
2021-12-01
影响因子：
6.3
通讯作者：
Ebata, Tomoki
中科院分区：
文献类型：
--
作者：
Fukaya, Masahide;Yokoyama, Yukihiro;Ebata, Tomoki
背景和目标：为探讨合生元对食管癌新辅助化疗期间细菌移位及菌血症的影响，将食管癌新辅助化疗患者随机分为合生元组（n = 10）和对照组（n = 10），分别于化疗前、化疗后及手术前1 d采集血液和粪便标本。在剖腹手术时（MLN-1）和肿瘤切除后（MLN-2）收获肠系膜淋巴结（MLN）。检测每个样品中的细菌。还测定了粪便微生物群和有机酸浓度。主要终点是血液样本中细菌的检测，以及化疗期间副作用的发生率。次要终点是在手术过程中收集的MLN样本中细菌的检出率。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份血液样本中有16份检出细菌，而合生元组100份血液样本中仅2份检出细菌（p < 0.001）。此外，在对照组的34个MLN样品中的12个中检测到细菌，而在合生元组的38个MLN样品中未检测到细菌（p < 0.001）。细菌移位的抑制至少部分与合生元增加的粪便乙酸浓度以及降低的粪便pH值有关。合生元组化疗期间3级胃肠道毒性的发生率低于对照组（8/22 vs. 1/20，p = 0.022）。结论：食管癌新辅助化疗可能导致细菌移位和随后的菌血症，合生元可预防细菌移位和菌血症。(C)2021爱思唯尔有限公司和欧洲临床营养与代谢学会。All rights reserved.
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. (C) 2021 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.