Immunonutrition Changes Inflammatory Response in Colorectal Cancer: Results from a Pilot Randomized Clinical Trial

Abstract

Introduction: Surgery is the first choice of treatment for colorectal cancer. Nutritional support in the form of oral nutritional supplements (ONSs) in the preoperative period is widely accepted for reducing the incidence of perioperative complications, and immunonutrition is generally recommended. However, there is little clinical data regarding the impact of such treatment on tumor biology. Material and Methods: In this study, tumor tissue and blood samples were collected from 26 patients during preoperative colonoscopy at the time of clinical diagnosis (sample A). Group 1 received standard ONSs (3× Nutricia Nutridrink Protein per day) for 2 weeks before surgery. In group 2, immune ONSs (2× Nestle Impact Oral) were administered for the same duration. Tumor tissue (sample B) was then retrieved from the tumor after resection. Changes in the expression levels of inflammatory cytokines (TNF-α, interleukin 8 or chemokine (C-X-C motif) ligand (CXCL8), stromal cell-derived factor 1 (SDF1a), chemokine (C-X-C motif) ligand 6 (CXCL6), chemokine (C-X-C motif) ligand (CXCL2), myeloperoxidase (MPO), and CXCL1) were assessed during the perioperative course. Results: TNF-α expression differed after intervention between the two groups (immune group 31.63 ± 13.28; control group 21.54 ± 6.84; p = 0.049) and prior to and after intervention in the control group (prior to intervention 35.68 ± 24.41; after intervention 21.54 ± 6.84; p = 0.038). Changes in CXCL8 expression in the control group occurred prior to and after intervention (prior to intervention 2975.93 ± 1484.04; after intervention 1584.85 ± 1659.84; p = 0.041). CXCL1 expression was increased in the immune group and decreased in the control group (immune group 2698.27 (1538.14–5124.70); control group 953.75 (457.85–1534.60); p = 0.032). In both groups, a decrease in superficial neutrophil infiltration was observed, but this was only statistically significant in the immune group. There was no impact of the observed differences between the two groups on surgical outcomes (morbidity, length of stay, readmissions). Conclusions: Immunonutrition in the preoperative period compared with standard nutritional support may influence inflammatory cytokine expression and leukocyte infiltration in patients with colorectal cancer.

Effect of Enteral Immunonutrition in Patients Undergoing Surgery for Gastrointestinal Cancer: An Updated Systematic Review and Meta-Analysis

“…Table 1 and Supplementary Table 1 summarize the detailed characteristics of included studies. Nine studies were carried out from Japan ( 25 , 28 , 38 , 44 , 48 , 53 , 56 , 58 , 59 ), six from Poland ( 26 , 30 , 39 – 41 , 52 ), four from Italy ( 24 , 34 , 37 , 49 ), four from China ( 23 , 43 , 46 , 54 ), three from Spain ( 45 , 50 , 51 ), two from England ( 22 , 36 ), two from Switzerland ( 35 , 42 ), two from Turkey ( 27 , 55 ), one from Denmark ( 57 ), one from Korea ( 47 ), and one from Australia ( 29 ). A total of 3,692 patients undergoing surgery for gastrointestinal cancer were included in the 35 studies.…”

“…According to the type of control, 26 groups were on a standard diet, and 18 were no supplement. Seven of the tumor types were gastric cancers (24,26,28,(43)(44)(45)(46), seven were colorectal cancers (47)(48)(49)(50)(51)(52)59), five were esophageal cancers (25,29,53,54,58), three were periampullary cancers (including pancreatic cancer) (22,56,57), and others were mixed types (23,27,30,(34)(35)(36)(37)(38)(39)(40)(41)(42)55). In addition, malnutrition rates before intervention were reported in 20 of the 35 studies, with all participants well-nourished in four studies (25,37,42,48), all participants malnourished in four studies (34,40,41,55), and patients in the remaining 12 studies were mixed (22, 24, 28-30, 35, 39, 45, 47, 49, 56, 58).…”

The health risks of dysphagia for patients with head and neck cancer: a multicentre prospective observational study

“…It aims to strengthen the patient's immune defences, so as to reduce post-operative complications, in particular infections. We are therefore talking about artificial nutrition based on solutions enriched with nutrients with the aim of stimulating the host's immune response, improving the control of the inflammatory response and increasing nitrogen balance and protein synthesis after major surgery [ 26 , 27 ]. The immune-nutrients used are glutamine, arginine, polyunsaturated fatty acids (omega-3), nucleotides, taurine, vitamins A, E and C, beta-carotene and trace elements (zinc and selenium).…”

Personalized Immunotherapy in Colorectal Cancers: Where Do We Stand?

“…CRC is one of the cancers with high heterogeneity among patients and even within a tumor, which has challenged the treatment of this disease (6). Genetic and environmental differences, diverse mutations, differences in the infiltration of immune cells into the CRCME, and even differences in the nutrition and microbiome of patients cause extensive heterogeneity in CRC (16,17,(90)(91)(92).…”