Association Of Bacterial Translocation With Cachexia And Prognosis In Locally Advanced Gastric Cancer

Objective There is increasing evidence that cancer cachexia patients have high cytokines levels, and bacterial translocation (BT) could increase cytokines secretion. The present study was to investigate association of bacterial translocation with cachexia and its impact on the outcome of patients with locally advanced gastric cancer.Methods From January2008to July2009, all of the consecutive patients with gastric cancer admitted to our hospital for surgical treatment were prospectively considered. Cancer patients were considered cachectic if they had lost>10%of their pre-illness stable weight within6months and serum CRP>10mg/L. Polymerase chain reaction was performed to detect bacterial DNA (BactDNA) in peripheral blood of cancer patients and healthy controls. Cytokines levels were tested by enzyme-linked immunosorbent assay. Flow cytometry was used to detect immune indicators. All the enrolled patients were followed up for two years and the two-year survival rate was calculated.Results This study included110gastric cancer patients, of these, cachexia group consisted of60patients and non-cachexia group consisted of50patients, in addition to this,55healthy controls were studied. BT ratio was significant higher in cachectic patients than in non-cachectic patients (25.0%vs.8.0%, p=0.019) and healthy controls (25.0%vs.0.0%, p=0.000). BT-positive cachectic patients had significant higher levels of IL-la, IL-6, TNF-a, and IFN-y compared with BT-negative cachectic patients (p=0.012, p=0.003,p=0.036,p=0.017, respectively) and BT-positive non-cachectic patients (p=0.011,p=0.034,p=0.000,p=0.022, respectively). The two-year survival rate in BT-positive cachectic patients was significant lower than in BT-negative cachectic patients (p=0.023). The levels of CD3+T, CD4+T, NK cell and CD4+T/CD8+T in gastric cancer patients were lower as compared to healthy controls (p=0.023,p=0.031, p=0.016,p=0.041, respectively), whereas CD8+T level was significant higher in gastric cancer patients than in healthy controls (p=0.038).Conclusion BT may contribute to the development of cancer cachexia and influence the long term survival of locally advanced gastric cancer patients.