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. 2023 Aug 23:13:1229177.
doi: 10.3389/fonc.2023.1229177. eCollection 2023.

Interventional effects of oral microecological agents on perioperative indicators of colorectal cancer: a meta-analysis

Xueyan Wang  1 , Lijun Pan  2 , Feiqing Wang  3 , Fengxi Long  4 , Bing Yang  5 , Dongxin Tang  6
Affiliations

Interventional effects of oral microecological agents on perioperative indicators of colorectal cancer: a meta-analysis

Xueyan Wang et al. Front Oncol. .

Abstract

Purpose: To investigate the efficacy of the application of microecological agents in patients with perioperative colorectal cancer.

Methods: The seven electronic databases including PubMed, Cochrane Library, Excerpt Medica Database (Embase), Web of Science (WOS), Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), and Wan-fang Database were systematically searched for eligible studies from 2000 to February 2023.

Results: A total of 38 randomized controlled clinical trials were included in this study, with a total of 1765 patients in the microecological preparation group and 1769 patients in the control group. All data were analyzed using Review Manager 5.4 and R 4.2.2 software. Meta-analysis showed that in the perioperative period of colorectal cancer, the microecological agents group reduced patients' adverse drug reactions, improved intestinal flora with Lactobacillus (SMD, 3.0858, [2.0197; 4.1520], p< 0. 0001), Bifidobacterium (SMD, 2.1551, [1.6145; 2.6956], p< 0.0001) and Escherichia coli (SMD, -1.1393, [-1.6247; -0.6538], p< 0.0001); protection of intestinal mucosal barrier function, endotoxin (SMD, -2.6850 [-4.1399; -1.2301], p=0.0003), DAO (SMD, -2.5916, [-3.4694; -1.7137], p<0.0001) and plasma D-lactate (SMD, -5.4726, [-9.8901; -1.0551], p= 0.0152), reduced inflammatory response, IL-6 (SMD, -3.1279 [-5.7706; -0.4852], p=0.0204) and CRP (SMD, -3.9698 [-7.6296; -0.3100], p=0.0335); improved the immune function of the organism, CD4+ (SMD, 1.5817 [1.0818; 2.0817], p< 0.0001), CD4+/CD8+ (SMD, 1.2938 [0.9693; 1.6183] p< 0.0001) and IgG (SMD, 1.1376 [0.2993; 1.9759] p=0.0078), improved short-term clinical efficacy, ORR (RR, 1.5105 [1.2306; 1.8541], p< 0.0001) and DCR (RR, 0.3896 [0.2620; 0.5795], p< 0.0001).

Conclusion: By increasing the number of beneficial flora such as Lactobacillus and Bifidobacterium and decreasing the number of harmful flora such as Escherichia coli, the micro-ecological preparation group is beneficial in improving the ecological dysregulation in colorectal cancer patients receiving different treatments in the perioperative period. The microecological preparation group was able to reduce many types of adverse drug reactions, such as infections and gastrointestinal discomfort, compared to the control group. The microecological agents also reduced inflammatory responses, decreased the increase in harmful metabolites, enhanced patients' immune function, protected intestinal mucosal barrier function, and improved short-term clinical outcomes.

Systematic review registration: https://inplasy.com/inplasy-2023-4-0051/, identifier INPLASY202340051.

Keywords: colorectal cancer; intestinal flora; meta-analysis; microecological agents; perioperative period.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
The flow charts of included studies.
Figure 2
Figure 2
Adverse drug reactions (A) Forest plot of lung infection analysis results. (B) Forest plot of incision infection analysis results. (C) Forest plot of leukopenia analysis results. (D) Forest plot of nausea analysis results. (E) Forest plot of vomiting analysis results. (F) Forest plot of diarrhea analysis results. (G) Forest plot of the results of the analysis of gastrointestinal distension. (H) Forest plot of the results of anastomotic fistula analysis. (I) Forest plot of the results of the analysis of abdominal infections. (J) Forest plot of urinary tract infection analysis results. (K) Forest plot of the results of the analysis of intestinal infections.
Figure 3
Figure 3
Altered intestinal flora. (A) Forest plot of the results of Lactobacillus analysis. (B) Forest plot of the results of Bifidobacterium analysis. (C) Forest plot of the results of E. coli analysis. (D) Forest plot of the results of the analysis of Enterococcus faecalis.
Figure 4
Figure 4
Short-term clinical efficacy. (A) Forest plot of ORR analysis results. (B) Forest plot of DCR analysis results.
Figure 5
Figure 5
Intestinal mucosal barrier function. (A) Forest plot of endotoxin analysis results. (B) Forest plot of DAO analysis results. (C) Forest plot of plasma D-lactate analysis results.
Figure 6
Figure 6
Immune function (A) Forest plot of CD4+ analysis results. (B) Forest plot of CD8+ analysis results. (C) Forest plot of CD4+/CD8+ analysis results. (D) Forest plot of IgA analysis results. (E) Forest plot of IgG analysis results.
Figure 7
Figure 7
Inflammatory factors. (A) Forest plot of IL-6 analysis results. (B) Forest plot of TNF-α analysis results. (C) Forest plot of CRP analysis results.
Figure 8
Figure 8
Publication bias analysis. (A) Lactobacillus. (B) Bifidobacterium. (C) Escherichia coli. (D) Enterococcus faecalis. (E) Lung infection (F) Incisional infections. (G) Nausea. (H) Vomiting. (I) Diarrhea. (J) CD4+. (K) CD8+. (L) CD4+/CD8+. (M) TNF-α.
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References

    1. Sharma R, Abbasi-Kangevari M, Abd-Rabu R, Abidi H, Abu-Gharbieh E, Acuna JM, et al. . Global, regional, and national burden of colorectal cancer and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Gastroenterol Hepatol (2022) 7(7):627–47. doi: 10.1016/S2468-1253(22)00044-9 - DOI - PMC - PubMed
    1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. . Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: Cancer J Clin (2021) 71(3):209–49. doi: 10.3322/caac.21660 - DOI - PubMed
    1. Neugent ML, Hulyalkar NV, Nguyen VH, Zimmern PE, De Nisco NJ. Advances in understanding the human urinary microbiome and its potential role in urinary tract infection. mBio (2020) 11(2):e00218-20. doi: 10.1128/mBio.00218-20 - DOI - PMC - PubMed
    1. Sender R, Fuchs S, Milo R. Are we really vastly outnumbered? Revisiting the ratio of bacterial to host cells in humans. Cell (2016) 164(3):337–40. doi: 10.1016/j.cell.2016.01.013 - DOI - PubMed
    1. de Vos WM, Tilg H, Van Hul M, Cani PD. Gut microbiome and health: mechanistic insights. Gut (2022) 71(5):1020–32. doi: 10.1136/gutjnl-2021-326789 - DOI - PMC - PubMed

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