The Effects of Preoperative Oral Carbohydrate on Frequency of T and NK Cells in Patients with Cervical Cancer Treated Using Neoadjuvant Chemotherapy and Surgery: A Prospective Cohort Study

BACKGROUND: Immune dysfunction can occur after neoadjuvant chemotherapy (NAC) and surgery for cancer. We investigated whether preoperative oral carbohydrate affected the postoperative percentages of T cells (CD4(+) and CD8(+)) and natural killer (NK) cells in patients with cervical cancer treated with NAC and surgery. METHODS: This prospective cohort study enrolled consecutive patients with cervical cancer treated by radical hysterectomy with PLND at the Gynecologic Oncology Department of Fujian Provincial Cancer Hospital (China) between January 2018 and December 2018. Patients were divided into three groups according to the treatment method: NAC (two cycles, surgery 1 month later), NAC+CHO (chemotherapy and surgical methods same as with the NAC group but with 300 mL of oral carbohydrate administered 2 h before surgery), and non-NAC (surgery alone). Percentages of NK, CD3(+), CD4(+), and CD8(+) cells were evaluated by flow cytometry the day after the first admission, just before surgery, immediately after tracheal tube removal, and the day after surgery. This trial is registered with NCT03872635 at clinicaltrials.com. RESULTS: The final analysis included 77 patients (non-NAC group, n = 26; NAC group, n = 25; and NAC-CHO group, n = 26). Baseline characteristics and preoperative NK, CD3(+), CD4(+), and CD8(+) cell percentages were similar between groups. Postoperatively, all groups exhibited reductions in NK, CD3(+), and CD4(+) cell percentages and increases in CD8(+) cell percentages (all P < 0.05). The changes in NK, CD3(+), CD4(+), and CD8(+) cell percentages were attenuated in the NAC-CHO group (P < 0.05 vs. both other groups). CONCLUSION: Preoperative oral carbohydrate can improve the postoperative populations of NK and T cells after the treatment of cervical cancer by NAC and surgery.