共识、指南与标准

肿瘤免疫营养治疗指南

展开
  • 1.吉林大学第一医院肿瘤中心, 长春130021; 2. 陆军军医大学新桥医院肿瘤科, 重庆404100; 3. 郑州大学第一附属医院生物细胞治疗中心, 郑州450052; 4.中国人民解放军成都军区总医院肿瘤诊治中心, 成都610083; 5. 西安交通大学医学院第一附属医院普通外科, 西安710061; 6. 宁夏医科大学总医院肿瘤医院肿瘤内科, 银川 750003; 7. 安徽医科大学第一附属医院胃肠外科, 合肥230022; 8.海军军医大学免疫研究所, 上海200433; 9. 浙江省肿瘤医院胃肠肿瘤内科, 杭州310022;10. 中山大学附属第七医院精准医学研究中心, 深圳518034,广东; 11.陆军军医大学大坪医院胃肠外科, 重庆400042; 12.东南大学医学院附属徐州医院/徐州市中心医院肿瘤内科, 徐州221009,江苏; 13. 福建省肿瘤医院肿瘤免疫科, 福州350014; 14. 福建省肿瘤医院乳腺外科, 福州350014; 15.河北医科大学第二医院血液科, 石家庄050003; 16. 河南省肿瘤医院生物免疫治疗科, 郑州450008; 17. 河南省肿瘤医院临床营养科, 郑州450008; 18. 哈尔滨医科大肿瘤医院肿瘤内科, 哈尔滨150001; 19. 苏州大学附属第三医院消化内科, 常州213003,江苏; 20.辽宁省肿瘤医院放疗一科, 沈阳110042; 21. 南昌医科大学第一附属医院肿瘤化放疗科, 南昌330006; 22.青海省人民医院肿瘤外科, 西宁810007; 23. 山东大学齐鲁医院胃肠外科, .济南250012; 24. 山西白求恩医院普外科, 太原030032; 25. 汕头大学医学院神经科学中心, 汕头515041,广东; 26.沈阳药科大学生命科学与生命制药学院, 沈阳110016; 27. 首都医科大学附属北京世纪坛医院神经肿瘤综合治疗病区, 北京100038; 28. 天津市南开医院肝胆外科, 天津300193; 29. 天津医科大学肿瘤医院生物治疗科, 天津300060; 30.潍坊医学院附属医院肿瘤科, 潍坊261031,山东; 31. 武汉大学中南医院肿瘤放化疗科, 武汉430071; 32. 西安交通大学附属陕西省肿瘤医院肿瘤内科, 西安710061; 33.新疆医科大学附属肿瘤医院日间医院, 乌鲁木齐830011; 34.遵义医药高等专科学校科研处, 遵义563006,贵州; 35.广州医科大学附属第三医院荔湾医院肿瘤内科, 广州510175; 36.上海交通大学医学院附属新华医院临床研究中心, 上海200092; 37.首都医科大学附属北京世纪坛医院/北京大学第九临床医学院胃肠外科, 北京100038

网络出版日期: 2021-04-12

基金资助

国家重点研发计划项目(2017YFC1309200);吉林省科学技术厅科技发展计划项目(20180101009JC;20190303146SF)

Guideline on cancer immunonutrition

Expand
  • 1.Department of Oncology Center, the First Hospital of Jilin University, Changchun 130021, Jilin, China; 2.Department of Oncology, Xinqiao Hospital of Army Medical University, Chongqing 404100, China; 3.Biological Cell Therapy Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan, China; 4.Cancer Diagnosis and Treatment Center, General Hospital  of Chengdu  Military Region,  Chengdu 610083, Sichuan, China; 5.Department of General Surgery, the First Affiliated Hospital of Xi′an Jiaotong University, Xi′an 710061, Shaanxi, China; 6.Department of Oncology Center, Cancer Hospital of General Hospital of Ningxia Medical University, Yinchuan 750003, Ningxia, China; 7.Department of Gastroenterology,  the First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui, China; 8.Institute of Immunology, the Second Military Medical University, Shanghai 200433, China; 9.Department of Gastroenterology and Oncology, Zhejiang Cancer Hospital, Hangzhou 310022, Zhejiang, China; 10 .Precision Medicine Research Center,  the  Seventh Affiliated Hospital of Sun Yat Sen University, Shenzhen 518034, Guangdong, China; 11.Department of Gastroenterology, Daping Hospital,  Army Medical University, Chongqing 400042, China; 12 .Department of Oncology Center, Xuzhou Central Hospital, Xuzhou 221009, Jiangsu, China; 13.Department of Oncoimmunology, Fujian Cancer Hospital, Fuzhou 350014, Fujian, China; 14.Department of Galactophore Surgery, Fujian Cancer Hospital, Fuzhou 350014, Fujian, China; 15.Department of Hematology, the  Second Hospital of Hebei Medical University, Shijiazhuang 050003, Hebei, China; 16.Department of Biological Immunotherapy,Henan Cancer Hospital, Zhengzhou 450008, Henan, China; 17.Department of Clinical Nutrition, Henan Cancer Hospital, Zhengzhou 450008, Henan, China; 18.Department of Oncology, Cancer Hospital of Harbin Medical University, Harbin 150001, Heilongjiang, China; 19.Department of Gastroenterology,  the  Third Affiliated Hospital of Suzhou University, Changzhou 213003, Jiangsu, China; 20 .Department of Radiotherapy, Liaoning Cancer Hospital, Shenyang 110042, Liaoning, China; 21.Department of Tumor Chemoradiotherapy, the First Affiliated Hospital of Nanchang Medical University, Nanchang 330006, Jiangxi, China; 22.Department of Oncology Surgery, Qinghai Provincial People’s Hospital, Xining 810007, Qinghai, China; 23.Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan 250012, Shandong, China; 24.Department of General Surgery, Shanxi Bethune Hospital, Taiyuan 030032, Shanxi, China; 25.Neuroscience Center, Shantou University Medical College, Shantou 515041, Guangdong, China; 26.School of Life Sciences and Life Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, Liaoning,China; 27.Neurotumor Comprehensive Treatment Center, Beijing Shijitan Hospital, Beijing 100038, China; 28.Department of Hepatobiliary Surgery, Tianjin Hospital of ITCWN Nankai Hospital, Tianjin 300193, China; 29.Department of Biotherapy, Tianjin Medical University Cancer Institute & Hospital, Tianjin 300060, China; 30.Department of Oncology, Affiliated Hospital of Weifang Medical College, Weifang 261031, Shandong, China; 31.Cancer Radiotherapy and Chemotherapy Department, Zhongnan Hospital of Wuhan University, Wuhan 430071, Hubei, China; 32.Department of Oncology Center, Shaanxi Cancer Hospital Affiliated to Xi′an Jiaotong University, Xi′an 710061, Shaanxi, China; 33.Day Ward, Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi 830011, Xinjiang, China; 34.Office of Academic Research, Zunyi Medical and Pharmacutical College, Zunyi, 563006, Guizhou, China; 35.Department of Oncology, Liwan Hospital of the Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510175, Guangdong, China; 36.Clinical Research Center, Xinhua Hospital Affiliated to Shanghai Jiaotong University of Medicine, Shanghai 200092, China; 37.Department of Gastrointestinal Surgery, Beijing Shijitan Hospital, Capital Medical University/the Ninth Clinical Medical College of Peking University, Beijing 100038, China

Online published: 2021-04-12

摘要

免疫营养是一种对肿瘤发生发展过程中的免疫、代谢和炎症变化具有重要调节作用的靶向性营养治疗,是肿瘤营养治疗的重要分支,已在手术、放化疗及肿瘤并发症治疗等多个领域得到广泛应用。然而,虽然已有多项国际营养指南述及免疫营养素在肿瘤临床治疗中的应用,但多数仅作为指南中零散的部分,缺乏系统的整理和归纳,并且部分指南中相关内容及临床研究结果尚存在争议。此外,现阶段人们对肿瘤免疫营养素的具体作用机制和疗效等方面认识的不足,进一步导致了免疫营养在临床实践中应用的局限性和不规范性。因此,为了更好地指导临床实践,在循证医学的指引下,通过对近年来发表的重要临床研究结果和权威指南的收集和整理,中国抗癌协会肿瘤营养专业委员会专家对各种研究证据进行了系统分析和反复校对,并根据牛津循证医学中心意见分级标准的证据和推荐水平提出了严格的推荐意见,对《肿瘤免疫营养治疗指南》(2016年)予以更新,以期为临床肿瘤患者规范化的免疫营养治疗提供参考和依据。

本文引用格式

崔久嵬,卓文磊,黄岚,许川,孙学军,刘玉迪,田慧敏,梁婷婷,陈萍,陈博,刘秋燕,应杰儿,李宁宁,张安平,于洋,周智峰,吴秀凤,郭晓玲,赵玲娣,翟军亚,杨朝阳,杨 . 肿瘤免疫营养治疗指南[J]. 肿瘤代谢与营养电子杂志, 2020 , 7(2) : 160 -168 . DOI: 10.16689/j.cnki.cn11-9349/r.2020.02.006

Abstract

Immunonutrition is a kind of targeted nutrition therapy that plays a significant role in the regulation of immune, metabolic and inflammatory changes during tumor development. It is an important branch of cancer nutrition therapy and has been widely used in many fields, such as surgery, radiotherapy and chemotherapy, and the treatment of cancer complications. However, although several international nutrition guidelines have addressed the use of immunonutrients in the clinical treatment of cancers, most of which are only scattered parts of the guidelines and lack of systematic collation and induction, and several relevant contents in the guidelines and clinical research results are still controversial. In addition, the deficient understanding of the specific mechanism and curative effect of tumor immune nutrients currently has further led to the limitation and non-standardization of immunonutrition in clinical practice. Therefore, in order to better guide clinical practice, through the collection and collation of critical clinical research results and authoritative guidelines published in recent years under the guidance of evidence-based medicine, experts of the Cancer Nutrition Committee of Chinese Anti Cancer Association have systematically analyzed and repeatedly proofread diverse research evidence, and put forward strict recommendations according to the evidence and recommendation levels in the rating criteria of Oxford Centre for Evidence-based Medicine, with a view to update the 2016 cancer immunonutrition guideline and provide a reference and basis for future standardized immunonutrition therapy for clinical cancer patients.

参考文献

1.DALY J M, LIEBERMAN M D, GOLDFINE J, et al. Enteral nutrition with supplemental arginine, RNA, and omega-3 fatty acids in patients after operation:  immunologic, metabolic, and clinical outcome[J]. Surgery, 1992, 112(1): 56-67.
2.MARIMUTHU K, VARADHAN K K, LJUNGQVIST O, et al. A meta-analysis of the effect of combinations of immune modulating nutrients on outcome in patients undergoing major open gastrointestinal surgery[J]. Annals of surgery, 2012, 255(6): 1060-1068.
3.DROVER J W, DHALIWAL R, WEITZEL L, et al. Perioperative use of arginine-supplemented diets:  a systematic review of the evidence[J]. J Am Coll Surg, 2011, 212(3): 385-399.
4.SCARPA M, KOTSAFTI A, FASSAN M, et al. Immunonutrition before esophagectomy:  Impact on immune surveillance mechanisms[J]. Tumour Biol, 2017, 39(10): 1010428317728683.
5.PEKER K D, OZKANLI S S, AKYUZ C, et al. Preoperative immunonutrition regulates tumor infiltrative lymphocytes and increases tumor angiogenesis in gastric cancer patients[J].  Arch Med Sci,2017;13:1365-1372.
6.RUSSELL K, ZHANG H G, GILLANDERS L K, et al. Preoperative immunonutrition in patients undergoing liver resection:  A prospective randomized trial[J]. World journal of gastroenterology, 2019, 11(3): 305-317.
7.LUO Z, WANG J, ZHANG Z, et al. Efficacy of early enteral immunonutrition on immune function and clinical outcome for postoperative patients with gastrointestinal cancer[J]. JPEN J Parenter Enteral Nutr, 2018, 42(4): 758-765.
8.CHENG Y, ZHANG J, ZHANG L, et al. Enteral immunonutrition versus enteral nutrition for gastric cancer patients undergoing a total gastrectomy:  a systematic review and meta-analysis[J]. Bmc Gastroenterology, 2018, 18(1): 11.
9.LI K, XU Y, HU Y, et al. Effect of enteral immunonutrition on immune, inflammatory markers and nutritional status in gastric cancer patients undergoing gastrectomy:  a randomized double-blinded controlled trial[J]. J Invest Surg, 2019, 19: 1-10.
10.SCISLO L, PACH R, NOWAK A, et al. The impact of postoperative enteral immunonutrition on postoperative complications and survival in gastric cancer patients-randomized clinical trial[J].  Nutr Cancer, 2018, 70(3): 453-459.
11.MCKAY B P, LARDER A L, LAM V. Pre-Operative vs. peri-operative nutrition supplementation in hepatic resection for cancer:  a systematic review[J].  Nutr Cancer, 2019, 71(2): 179-98.
12.KANEKIYO S, TAKEDA S, IIDA M, et al. Efficacy of perioperative immunonutrition in esophageal cancer patients undergoing esophagectomy[J]. Nutrition, 2019, 59: 96-102.
13.LASSEN K, COOLSEN MME, SLIM K, et al. Guidelines for perioperative care for pancreaticoduodenectomy:  Enhanced Recovery After Surgery (ERAS) Society recommendations[J]. Clin Nutr, 2012, 31(6): 817-830.
14.GUSTAFSSON U O, SCOTT M J, SCHWENK W, et al. Guidelines for perioperative care in elective colonic surgery:  Enhanced Recovery After Surgery (ERAS) Society recommendations[J]. Clin Nutr, 2012, 31(6): 783-800.
15.ARENDS J, BACHMANN P, BARACOS V, et al. ESPEN guidelines on nutrition in cancer patients[J]. Clin Nutr, 2017, 36(1): 11-48.
16.WEI J, CHEN W, ZHU M, et al. Guidelines for parenteral and enteral nutrition support in geriatric patients in China[J]. Asia Pac J Clin Nutr, 2015, 24(2): 336-246.
17.ROWAN N R, JOHNSON J T, FRATANGELO C E, et al. Utility of a perioperative nutritional intervention on postoperative outcomes in high-risk head & neck cancer patients[J]. Oral Oncol, 2016, 54: 42-46.
18.AEBERHARD C, MAYER C, MEYER S, et al. Effect of preoperative immunonutrition on postoperative short-term outcomes of patients with head and neck squamous cell carcinoma[J]. Head neck, 2018, 40(5): 1057-1067.
19.BARAJAS-GALINDO D E, VIDAL-CASARIEGO A, PINTOR-DE LA MAZA B, et al. Postoperative enteral immunonutrition in head and neck cancer patients:  Impact on clinical outcomes[J]. Endocrinol Diabetes Nutr, 2020, 67(1): 13-19.
20.MUELLER S A, MAYER C, BOJAXHIU B, et al. Effect of preoperative immunonutrition on complications after salvage surgery in head and neck cancer[J]. J Otolaryngol Head Neck Surg, 2019, 48(1): 25.
21.WEIMANN A, BRAGA M, HARSANYI L, et al. ESPEN guidelines on enteral nutrition:  surgery including organ transplantation[J]. Clin Nutr, 2006, 25(2): 224-244.
22.HOWES N, ATKINSON C, THOMAS S, et al. Immunonutrition for patients undergoing surgery for head and neck cancer[J]. Cochrane Database Syst Rev, 2018, 8: CD010954.
23.HAMILTON-REEVES J M, STANLEY A, BECHTEL M D, et al. Perioperative immunonutrition modulates inflammatory response after radical cystectomy:  results of a pilot randomized controlled clinical trial[J]. J Urol, 2018, 200(2): 292-301.
24.KHEMISSA F, MINEUR L, AMSELLEM C, et al. A phase Ⅲ study evaluating oral glutamine and transforming growth factor-beta 2 on chemotherapy-induced toxicity in patients with digestive neoplasm[J]. Dig Liver Dis, 2016, 48(3): 327-332.
25.HAN Y, ZHANG F, WANG J, et al. Application of glutamine-enriched nutrition therapy in childhood acute lymphoblastic leukemia[J]. Nutr J, 2016, 15(1): 65.
26.WANG J, LI Y, QI Y. Effect of glutamine-enriched nutritional support on intestinal mucosal barrier function, MMP-2, MMP-9 and immune function in patients with advanced gastric cancer during perioperative chemotherapy[J]. Oncology Lett, 2017, 14(3): 3606-3610.
27.SANDS S, LADAS EJ, KELLY K M, et al. Glutamine for the treatment of vincristine-induced neuropathy in children and adolescents with cancer[J]. Support care cancer, 2017, 25(3): 701-708.
28.MAZZUCA F, ROBERTO M, ARRIVI G, et al. Clinical impact of highly purified, whey proteins in patients affected with colorectal cancer undergoing chemotherapy:  preliminary results of a placebo-controlled study[J]. Integr Cancer Ther, 2019, 18: 1534735419866920.
29.LOPEZ-VAQUERO D, GUTIERREZ-BAYARD L, RODRIGUEZ-RUIZ J A, et al. Double-blind randomized study of oral glutamine on the management of radio/chemotherapy-induced mucositis and dermatitis in head and neck cancer[J]. Mol Clin Oncol, 2017, 6(6): 931-936.
30.ROTOVNIK KOZJEK N, KOMPAN L, AGAR T, et al. Influence of enteral glutamine on inflammatory and hormonal response in patients with rectal cancer during preoperative radiochemotherapy[J]. Eur J Clin Nutr, 2017, 71(5): 671-673.
31.LINN Y H, THU K K, WIN N H H. Effect of probiotics for the prevention of acute radiation-induced diarrhoea among cervical cancer patients:  a randomized double-blind placebo-controlled study[J]. Probiotics Antimicrob Proteins, 2019, 11(2): 638-647.
32.PETERSON D E, BOERS-DOETS C B, BENSADOUN R J, et al. Management of oral and gastrointestinal mucosal injury:  ESMO clinical practice guidelines for diagnosis, treatment, and follow-up[J]. Ann Oncol, 2015, 26 Suppl 5: v139-v51.
33.THOMPSON K L, ELLIOTT L, FUCHS-TARLOVSKY V, et al. Oncology evidence-based nutrition practice guideline for adults[J]. J Acad Nutr Diet, 2017, 117(2): 297-310.e47.
34.IYAMA S, SATO T, TATSUMI H, et al. Efficacy of enteral supplementation enriched with glutamine, fiber, and oligosaccharide on mucosal injury following hematopoietic stem cell transplantation[J]. Case Rep Oncol, 2014, 7(3): 692-699.
35.KOTA H, CHAMBERLAIN R S. Immunonutrition is associated with a decreased incidence of graft-versus-host disease in bone marrow transplant recipients:  a meta-analysis[J]. JPEN J Parenter Enteral Nutr, 2017, 41(8): 1286-1292.
36.BOZZETTI F, ARENDS J, LUNDHOLM K, et al. ESPEN guidelines on parenteral nutrition:  non-surgical oncology[J]. Clin Nutr, 2009, 28(4): 445-454.
37.CHO Y K, HONG S Y, JEON S J, et al. Efficacy of parenteral glutamine supplementation in adult hematopoietic stem cell transplantation patients[J]. Blood research, 2019, 54(1): 23-30.
38.SHIRAI Y, OKUGAWA Y, HISHIDA A, et al. Fish oil-enriched nutrition combined with systemic chemotherapy for gastrointestinal cancer patients with cancer cachexia[J].  Sci Rep, 2017, 7(1): 4826.
39.KITAGAWA M, HAJI S, AMAGAI T. Elevated serum AA/EPA ratio as a predictor of skeletal muscle depletion in cachexic patients with advanced gastro-intestinal cancers[J]. In Vivo, 2017, 31(5): 1003-1009.
40.MOCHAMA T, CUHLS H, MARINOVA M, et al. A systematic review on the role of vitamins, minerals, proteins, and other supplements for the treatment of cachexia in cancer:  a European Palliative Care Research Centre cachexia project[J]. J cachexia sarcopenia muscle, 2016.
41.濱口哲也,三木誓雄.がん患者の代謝と栄養[J].日本静脈経腸栄養学会雑誌, 2015, 30(4): 911-916.
42.NYGREN J, THACKER J, CARLI F, et al. Guidelines for perioperative care in elective rectal/pelvic surgery:  Enhanced Recovery After Surgery (ERAS) Society recommendations[J].  Clin Nutr, 2012, 31(6): 801-816.
43.MCCLAVE S A, MARTINDALE R G, VANEK V W, et al. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient:  Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.)[J]. JPEN J Parenter Enteral Nutr, 2009, 33(3): 277-316.
44.HEYLAND D K, DHALIWAL R, DROVER J W, et al. Canadian clinical practice guidelines for nutrition support in mechanically ventilated, critically ill adult patients[J]. JPEN J Parenter Enteral Nutr, 2003, 27(5): 355-373.
文章导航

/