Abstract：
BACKGROUND: There is increasing awareness of the importance of nutritional support in cancer treatment including the interaction with immunity. Immunonutrition is the provision of one or more nutrients (e.g. Vitamins A, D, or E, omega-3 fatty acids, arginine and glutamine) known to modulate immune function when given at levels above those normally encountered in the diet in order to support immune system function or modulate its activity, including control of inflammation. We reviewed the role of oral or enteral immunonutrition versus standard nutrition on infection and infection-related biomarkers in adult cancer patients undergoing chemotherapy.
METHODS: A systematic search of oral or enteral immunonutrition versus standard nutrition in adult cancer patients during chemotherapy with or without radiotherapy or haematopoietic stem cell transplant was conducted in MEDLINE, EMBASE and CENTRAL. The search was limited to randomised controlled trials. Our primary outcome was infectious episodes or immune-related biomarkers (e.g. immune cell numbers, inflammatory markers). Secondary outcomes included incidence of malnutrition or cachexia, non-infection related adverse events (AEs), rate of remission, survival, and delays or incomplete cycles of chemotherapy. Risk of bias was assessed using ROB 2.0 and study quality was assessed using CASP for RCTs.
RESULTS: The search yielded seven studies involving 521 patients (261 immunonutrition, 260 control) for analysis. All studies enrolled patients with solid tumours (no haematological malignancies). Studies were heterogenous for cancer type (upper gastrointestinal, head and neck, pancreatic and lung), immunonutrient composition (omega-3 fatty acids, vitamin A, E, glutamine, arginine or nucleotides), delivery route (enteral nutrition or oral nutritional supplement) and control used. Intervention period ranged from 4 to 14 weeks. No study reported absolute number of infections. Three studies reported AEs including potential infectious episodes of febrile neutropenia, pneumonitis and mucositis with oral candidiasis. Some studies report a decrease in blood concentrations of CRP and TNF-α with immunonutrition.
CONCLUSIONS: There is currently insufficient evidence to define a role for immunonutrition on infectious episodes during chemotherapy in adult cancer patients. Further well-defined studies that account for degree of malnutrition, dose, timing and duration of immunonutrition in specific well-defined cancer groups using a standardised outcome framework are needed.
METHODS: A systematic search of oral or enteral immunonutrition versus standard nutrition in adult cancer patients during chemotherapy with or without radiotherapy or haematopoietic stem cell transplant was conducted in MEDLINE, EMBASE and CENTRAL. The search was limited to randomised controlled trials. Our primary outcome was infectious episodes or immune-related biomarkers (e.g. immune cell numbers, inflammatory markers). Secondary outcomes included incidence of malnutrition or cachexia, non-infection related adverse events (AEs), rate of remission, survival, and delays or incomplete cycles of chemotherapy. Risk of bias was assessed using ROB 2.0 and study quality was assessed using CASP for RCTs.
RESULTS: The search yielded seven studies involving 521 patients (261 immunonutrition, 260 control) for analysis. All studies enrolled patients with solid tumours (no haematological malignancies). Studies were heterogenous for cancer type (upper gastrointestinal, head and neck, pancreatic and lung), immunonutrient composition (omega-3 fatty acids, vitamin A, E, glutamine, arginine or nucleotides), delivery route (enteral nutrition or oral nutritional supplement) and control used. Intervention period ranged from 4 to 14 weeks. No study reported absolute number of infections. Three studies reported AEs including potential infectious episodes of febrile neutropenia, pneumonitis and mucositis with oral candidiasis. Some studies report a decrease in blood concentrations of CRP and TNF-α with immunonutrition.
CONCLUSIONS: There is currently insufficient evidence to define a role for immunonutrition on infectious episodes during chemotherapy in adult cancer patients. Further well-defined studies that account for degree of malnutrition, dose, timing and duration of immunonutrition in specific well-defined cancer groups using a standardised outcome framework are needed.
摘要：
背景：人们越来越意识到营养支持在癌症治疗中的重要性，包括与免疫的相互作用。免疫营养素是提供一种或多种营养素(如维生素A、D,或者E，omega-3脂肪酸，精氨酸和谷氨酰胺）已知以高于饮食中通常遇到的水平来调节免疫功能，以支持免疫系统功能或调节其活性，包括控制炎症。我们回顾了口服或肠内免疫营养与标准营养对接受化疗的成年癌症患者感染和感染相关生物标志物的作用。
方法：在MEDLINE中，对有或没有放疗或造血干细胞移植的成年癌症患者进行了口服或肠内免疫营养与标准营养的系统搜索，EMBASE和中央。搜索仅限于随机对照试验。我们的主要结果是感染发作或免疫相关的生物标志物（例如免疫细胞数，炎性标记物)。次要结果包括营养不良或恶病质的发生率，非感染相关不良事件（AE），缓解率,生存,和延迟或不完整的化疗周期。使用ROB2.0评估偏倚风险，使用CASP进行RCT评估研究质量。
结果：搜索产生了七项研究，涉及521名患者（261种免疫营养素，260对照)进行分析。所有研究均纳入实体瘤患者（无血液恶性肿瘤）。癌症类型的研究是异质性的(上消化道，头部和颈部,胰腺和肺)，免疫营养素组合物（omega-3脂肪酸，维生素A,E,谷氨酰胺,精氨酸或核苷酸)，使用的分娩途径(肠内营养或口服营养补充剂)和对照。干预期为4～14周。没有研究报告感染的绝对数量。三项研究报告了AE，包括发热性中性粒细胞减少症的潜在感染发作，肺炎和粘膜炎伴口腔念珠菌病。一些研究报告了免疫营养素降低了血液中CRP和TNF-α的浓度。
结论：目前没有足够的证据来确定免疫营养在成年癌症患者化疗期间感染事件中的作用。进一步明确的研究，说明营养不良的程度，剂量,需要在特定明确的癌症组中使用标准化结局框架进行免疫营养的时间和持续时间.
方法：在MEDLINE中，对有或没有放疗或造血干细胞移植的成年癌症患者进行了口服或肠内免疫营养与标准营养的系统搜索，EMBASE和中央。搜索仅限于随机对照试验。我们的主要结果是感染发作或免疫相关的生物标志物（例如免疫细胞数，炎性标记物)。次要结果包括营养不良或恶病质的发生率，非感染相关不良事件（AE），缓解率,生存,和延迟或不完整的化疗周期。使用ROB2.0评估偏倚风险，使用CASP进行RCT评估研究质量。
结果：搜索产生了七项研究，涉及521名患者（261种免疫营养素，260对照)进行分析。所有研究均纳入实体瘤患者（无血液恶性肿瘤）。癌症类型的研究是异质性的(上消化道，头部和颈部,胰腺和肺)，免疫营养素组合物（omega-3脂肪酸，维生素A,E,谷氨酰胺,精氨酸或核苷酸)，使用的分娩途径(肠内营养或口服营养补充剂)和对照。干预期为4～14周。没有研究报告感染的绝对数量。三项研究报告了AE，包括发热性中性粒细胞减少症的潜在感染发作，肺炎和粘膜炎伴口腔念珠菌病。一些研究报告了免疫营养素降低了血液中CRP和TNF-α的浓度。
结论：目前没有足够的证据来确定免疫营养在成年癌症患者化疗期间感染事件中的作用。进一步明确的研究，说明营养不良的程度，剂量,需要在特定明确的癌症组中使用标准化结局框架进行免疫营养的时间和持续时间.
