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Lu W, Aihaiti A, Abudukeranmu P, Liu Y, Gao H. Unravelling the role of intratumoral bacteria in digestive system cancers: current insights and future perspectives. J Transl Med 2024; 22:545. [PMID: 38849871 PMCID: PMC11157735 DOI: 10.1186/s12967-024-05320-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 05/18/2024] [Indexed: 06/09/2024] Open
Abstract
Recently, research on the human microbiome, especially concerning the bacteria within the digestive system, has substantially advanced. This exploration has unveiled a complex interplay between microbiota and health, particularly in the context of disease. Evidence suggests that the gut microbiome plays vital roles in digestion, immunity and the synthesis of vitamins and neurotransmitters, highlighting its significance in maintaining overall health. Conversely, disruptions in these microbial communities, termed dysbiosis, have been linked to the pathogenesis of various diseases, including digestive system cancers. These bacteria can influence cancer progression through mechanisms such as DNA damage, modulation of the tumour microenvironment, and effects on the host's immune response. Changes in the composition and function within the tumours can also impact inflammation, immune response and cancer therapy effectiveness. These findings offer promising avenues for the clinical application of intratumoral bacteria for digestive system cancer treatment, including the potential use of microbial markers for early cancer detection, prognostication and the development of microbiome-targeted therapies to enhance treatment outcomes. This review aims to provide a comprehensive overview of the pivotal roles played by gut microbiome bacteria in the development of digestive system cancers. Additionally, we delve into the specific contributions of intratumoral bacteria to digestive system cancer development, elucidating potential mechanisms and clinical implications. Ultimately, this review underscores the intricate interplay between intratumoral bacteria and digestive system cancers, underscoring the pivotal role of microbiome research in transforming diagnostic, prognostic and therapeutic paradigms for digestive system cancers.
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Affiliation(s)
- Weiqin Lu
- General Surgery, Cancer Center, Department of Vascular Surgery, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | | | | | - Yajun Liu
- Aksu First People's Hospital, Xinjiang, China
| | - Huihui Gao
- Cancer Center, Department of Hospital Infection Management and Preventive Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China.
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Loyala JV, Down B, Wong E, Tan B. Treatment of Cachexia in Gastric Cancer: Exploring the Use of Anti-Inflammatory Natural Products and Their Derivatives. Nutrients 2024; 16:1246. [PMID: 38674936 PMCID: PMC11053965 DOI: 10.3390/nu16081246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 04/12/2024] [Accepted: 04/19/2024] [Indexed: 04/28/2024] Open
Abstract
(1) Background: Gastric cancer is a significant cause of cancer-related mortality worldwide. Weight loss and malnutrition associated with cancer are linked with increased mortality rates and reduced quality of life. Cancer cachexia, characterised by the loss of skeletal muscle, is associated with approximately 20% of cancer-related deaths and differs from malnutrition in that it cannot be fully reversed by nutritional support alone. It is now recognised that the primary pathophysiological process underlying cancer cachexia is chronic inflammation leading to increased calorie consumption. Current treatments that focus on nutritional supplementation, psychological counselling, appetite stimulation and reducing inflammation are lacking in efficacy. This review focuses on the evidence supporting the potential roles of natural anti-inflammatory products and their derivatives including fatty acids, probiotics, amino acids, curcumin, fucoidan, epigallocatechin-3-gallate, ginger, resveratrol and Boswellia serrata in the management of gastric cancer cachexia. (2) Results: While natural anti-inflammatory products show promise in a number of in vitro and in vivo studies, there are only a small number of human studies available. Where present, the evidence base is heterogeneous, with varying study methodologies and outcomes. (3) Conclusions: Natural anti-inflammatory products represent a potential adjunctive therapy for gastric cancer cachexia. Further research, particularly well-designed clinical trials, is needed to elucidate their optimal role, dosing and safety profiles in the management of gastric cancer cachexia.
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Affiliation(s)
- Jerocin Vishani Loyala
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2GW, UK
| | - Billy Down
- High Wycombe Hospital, Buckinghamshire Healthcare NHS Trust, High Wycombe HP11 2TT, UK;
| | - Enoch Wong
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2GW, UK
| | - Benjamin Tan
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham B15 2TT, UK;
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Patel I, Winer A. Assessing Frailty in Gastrointestinal Cancer: Two Diseases in One? Curr Oncol Rep 2024; 26:90-102. [PMID: 38180691 DOI: 10.1007/s11912-023-01483-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2023] [Indexed: 01/06/2024]
Abstract
PURPOSEOF REVIEW This review examines the challenges of treating gastrointestinal cancer in the aging population, focusing on the importance of frailty assessment. Emphasized are the rise in gastrointestinal cancer incidence in older adults, advances in frailty assessments for patients with gastrointestinal cancer, the development of novel frailty markers, and a summary of recent trials. RECENT FINDINGS Increasing evidence suggests that the use of a Comprehensive Geriatric Assessment (CGA) to identify frail older adults and individualize cancer care leads to lower toxicity and improved quality of life outcomes. However, the adoption of a full CGA prior to chemotherapy initiation in older cancer patients remains low. Recently, new frailty screening tools have emerged, including assessments designed to specifically predict chemotherapy-related adverse events. Additionally, frailty biomarkers have been developed, such as blood tests like IL-6 and performance tracking through physical activity monitors. The relevance of nutrition and muscle mass is discussed. Highlights from recent trials suggest the feasibility of successfully identifying patients most at risk of serious adverse events. There have been promising developments in identifying novel frailty markers and methods to screen for frailty in the older adult population. Further prospective trials that focus on and address the needs of the geriatric population for early identification of frailty in cancer care, facilitating a more tailored treatment approach. Practicing oncologists should select a frailty assessment to implement into their routine practice and adjust treatment accordingly.
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Affiliation(s)
- Ishan Patel
- Inova Schar Cancer Institute, 8081 Innovation Park Drive, Falls Church, Falls Church, VA, 22031, USA.
| | - Arthur Winer
- Inova Schar Cancer Institute, 8081 Innovation Park Drive, Falls Church, Falls Church, VA, 22031, USA
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Huang L, Zhao Q, Li W. A meta-analysis of randomized controlled trials comparing enteral immunonutrition (EIN) and standard enteral nutrition regarding biochemical, immunological, and clinical outcomes in gastrectomy patients with gastric cancer and investigating evidence networks for EIN formulae. Wideochir Inne Tech Maloinwazyjne 2023; 18:588-602. [PMID: 38239588 PMCID: PMC10793151 DOI: 10.5114/wiitm.2023.133439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 10/05/2023] [Indexed: 01/22/2024] Open
Abstract
Introduction For patients with gastric cancer who have undergone gastrectomy, recent research has shown that enteral immunonutrition (EIN) is more successful than enteral nutrition (EN) at boosting host immunity and, in turn, improving prognosis. The claimed outcomes, however, are inconsistent. Aim This meta-analysis examines how EIN affects biochemical, immunological, and clinical outcomes for gastrectomy (GC) patients following gastrectomy and EIN formulae evidence networks. Material and methods A comprehensive search of the Medline, EMBASE, Scopus, and Cochrane Library databases identified English-language peer-reviewed journal papers. The odds ratio (OR) and standard mean difference (SMD) were calculated, along with their 95% confidence intervals. The heterogeneity was assessed using Cochrane Q and I2 statistics and the appropriate p-value. The analysis used RevMan 5.3. Results This meta-analysis included 10 RCTs involving 1409 GC patients, 714 of whom were assigned to EIN and 695 to EN. After EIN treatment, serum proalbumin, serum transferrin, lymphocyte count, and CD4+/CD8+ ratio had statistically significant standardised mean differences (SMDs) of 2.39, 2.39, 1.34, and 0.72, respectively. EIN reduces postoperative infectious complications with an OR of 0.63 (95% CI: 0.41-0.77) for infections, an OR of 0.63 for complications, and an SMD of -1.05 for systemic inflammations. A network diagram with high-quality data and a well-defined network design with consistent and accurate connection shows that EIN can improve serum protein levels, immunological parameters, and post-operative problems. Conclusions The use of EIN has been shown to enhance cellular immunity, regulate inflammatory response, and decrease postoperative complications in GC patients who underwent major GI surgery.
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Affiliation(s)
- Lidan Huang
- Department of Anaesthesiology, Renmin Hospital of Wuhan University, Hubei Wuhan, China
| | - Qi Zhao
- Department of Gastrointestinal Neoplasms, The People’s Hospital of Dazu Chongqing ·Dazu Hospital Affiliated with Chongqing Medical University, Chongqing, China
| | - Weihang Li
- Department of Interventional Radiology, Harbin Medical University Cancer Hospital, Heilongjiang Harbin, China
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Martinelli S, Lamminpää I, Dübüş EN, Sarıkaya D, Niccolai E. Synergistic Strategies for Gastrointestinal Cancer Care: Unveiling the Benefits of Immunonutrition and Microbiota Modulation. Nutrients 2023; 15:4408. [PMID: 37892482 PMCID: PMC10610426 DOI: 10.3390/nu15204408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/12/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023] Open
Abstract
Gastrointestinal (GI) cancers are a group of highly prevalent malignant tumors affecting the gastrointestinal tract. Globally, one in four cancer cases and one in three cancer deaths are estimated to be GI cancers. They can alter digestive and absorption functions, leading to severe malnutrition which may worsen the prognosis of the patients. Therefore, nutritional intervention and monitoring play a fundamental role in managing metabolic alterations and cancer symptoms, as well as minimizing side effects and increasing the effectiveness of chemotherapy. In this scenario, the use of immunonutrients that are able to modulate the immune system and the modification/regulation of the gut microbiota composition have gained attention as a possible strategy to improve the conditions of these patients. The complex interaction between nutrients and microbiota might contribute to maintaining the homeostasis of each individual's immune system; therefore, concurrent use of specific nutrients in combination with traditional cancer treatments may synergistically improve the overall care of GI cancer patients. This work aims to review and discuss the role of immunonutrition and microbiota modulation in improving nutritional status, postoperative recovery, and response to therapies in patients with GI cancer.
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Affiliation(s)
- Serena Martinelli
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Firenze, Italy; (S.M.); (I.L.)
| | - Ingrid Lamminpää
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Firenze, Italy; (S.M.); (I.L.)
| | - Eda Nur Dübüş
- Department of Nutrition and Dietetics, Gazi University, 06560 Ankara, Turkey; (E.N.D.); (D.S.)
| | - Dilara Sarıkaya
- Department of Nutrition and Dietetics, Gazi University, 06560 Ankara, Turkey; (E.N.D.); (D.S.)
| | - Elena Niccolai
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Firenze, Italy; (S.M.); (I.L.)
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Park J, Kim J, Shin DW, Shin J, Cho B, Song YM. Factors Associated with Dietary Habit Changes in Korean Stomach Cancer Survivors after Cancer Treatment. Nutrients 2023; 15:3268. [PMID: 37513686 PMCID: PMC10385203 DOI: 10.3390/nu15143268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/13/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
The current nutritional guidelines for stomach cancer survivors (SCSs) mainly focus on the influence of the surgical resection of the stomach, with limited guidance regarding a wider range of food options. We aimed to investigate the factors associated with healthier dietary changes in Korean adult SCSs. This cross-sectional study assessed dietary pattern changes after cancer treatment for 11 food categories, using a self-administered questionnaire. A 'healthier dietary change' was operationally defined as a reduced consumption of red and processed meat, grains, salt, and burnt food, and an increased consumption of poultry, fish, vegetables, fruits, legumes, and dairy products. Among a total of 624 SCSs, approximately 60% of participants reported dietary changes in a healthier direction in three or more food categories, while 9.1% reported no changes. There was no significant difference in dietary habit changes between surgery types. Multivariable adjusted analysis showed that elderly and long-term survivors were inversely associated with a healthier dietary change. SCSs with a higher level of educational achievement and income were more likely to make healthier changes in their intake of processed meat, vegetables, fruits, burnt food, or salt. SCSs with higher levels of fear of cancer recurrence, anxiety, or depression were more likely to follow healthier dietary changes regarding fish, meat, fruits, grains, or burnt food. Change in dietary pattern varied across different food items, and was associated with various characteristics of SCSs. It is crucial to repeatedly provide SCSs with information about healthier dietary patterns, considering their sociodemographic, clinical, and psychological characteristics.
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Affiliation(s)
- Junhee Park
- Department of Family Medicine & Supportive Care Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (J.P.); (D.W.S.)
| | - Jiyoung Kim
- Department of Family Medicine & Health Promotion Center, Seoul National University Hospital, Seoul 03080, Republic of Korea; (J.K.)
| | - Dong Wook Shin
- Department of Family Medicine & Supportive Care Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (J.P.); (D.W.S.)
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute of Health Science and Technology, Sungkyunkwan University, Seoul 06355, Republic of Korea
| | - Jinyoung Shin
- Department of Family Medicine, Konkuk University Medical Center, Seoul 05030, Republic of Korea;
| | - Belong Cho
- Department of Family Medicine & Health Promotion Center, Seoul National University Hospital, Seoul 03080, Republic of Korea; (J.K.)
| | - Yun-Mi Song
- Department of Family Medicine & Supportive Care Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (J.P.); (D.W.S.)
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Kutnik P, Borys M, Buszewicz G, Piwowarczyk P, Osak M, Teresiński G, Czuczwar M. Serum Ketone Levels May Correspond with Preoperative Body Weight Loss in Patients Undergoing Elective Surgery: A Single-Center, Prospective, Observational Feasibility Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116573. [PMID: 35682159 PMCID: PMC9180013 DOI: 10.3390/ijerph19116573] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 05/24/2022] [Accepted: 05/25/2022] [Indexed: 02/04/2023]
Abstract
Although nutritional-risk scoring systems allow the determination of the patient’s malnutrition at admission, additional tools might be useful in some clinical scenarios. Previous medical history could be unavailable in unconscious or demented patients. This study aimed to assess the ketone bodies serum levels in patients undergoing elective surgeries and to determine the possible correlation between ketone bodies serum levels and preoperative body weight loss. The study included 21 patients who underwent elective surgery. Hyperketonemia, defined as ketone bodies over 1 mmol/L, was observed in seven (33.3%) patients. Patients with hyperketonemia had significantly higher preoperative percentage body weight loss (p = 0.04) and higher nutritional risk scores prior to surgery (p = 0.04). Serum glucose and the percentage of body weight loss were associated with increased ketone bodies serum levels (Odds Ratios: 0.978 (0.961–0.996, p = 0.019) and 1.222 (1.0–1.492, p = 0.05), respectively). A significant linear correlation was found between the percentage of body weight loss and both ketones bodies (r2 = 0.25, p = 0.02) and albumin serum levels (r2 = 0.19, p = 0.04). Our study’s results might suggest a positive association between preoperative body weight loss and ketone bodies serum levels. The observation between increased ketone bodies serum levels in patients and preoperative body mass loss merits further research.
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Affiliation(s)
- Paweł Kutnik
- II Department of Anaesthesiology and Intensive Care, Medical University of Lublin, Staszica 16, 20-081 Lublin, Poland; (M.B.); (P.P.); (M.C.)
- Correspondence:
| | - Michał Borys
- II Department of Anaesthesiology and Intensive Care, Medical University of Lublin, Staszica 16, 20-081 Lublin, Poland; (M.B.); (P.P.); (M.C.)
| | - Grzegorz Buszewicz
- Laboratory of Forensic Toxicology, Department of Forensic Medicine, Medical University of Lublin, Jaczewskiego 8b, 20-090 Lublin, Poland; (G.B.); (M.O.)
| | - Paweł Piwowarczyk
- II Department of Anaesthesiology and Intensive Care, Medical University of Lublin, Staszica 16, 20-081 Lublin, Poland; (M.B.); (P.P.); (M.C.)
| | - Marcin Osak
- Laboratory of Forensic Toxicology, Department of Forensic Medicine, Medical University of Lublin, Jaczewskiego 8b, 20-090 Lublin, Poland; (G.B.); (M.O.)
| | - Grzegorz Teresiński
- Department of Forensic Medicine, Medical University of Lublin, Jaczewskiego 8b, 20-090 Lublin, Poland;
| | - Mirosław Czuczwar
- II Department of Anaesthesiology and Intensive Care, Medical University of Lublin, Staszica 16, 20-081 Lublin, Poland; (M.B.); (P.P.); (M.C.)
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