全身治疗前六个月内使用抗生素与较低的癌症生存率相关。

Antibiotic exposure within six months before systemic therapy was associated with lower cancer survival.

作者信息

Morrell Stephen, Kohonen-Corish Maija R J, Ward Robyn L, Sorrell Tania C, Roder David, Currow David C

机构信息

Cancer Institute NSW, Level 4, 1 Reserve Road St Leonards, Sydney, New South Wales, Australia.

Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia; Microbiome Research Centre, School of Clinical Medicine, UNSW Sydney and Faculty of Science, University of Technology Sydney, Sydney, New South Wales, Australia.

出版信息

J Clin Epidemiol. 2022 Jul;147:122-131. doi: 10.1016/j.jclinepi.2022.04.003. Epub 2022 Apr 6.

DOI:10.1016/j.jclinepi.2022.04.003

PMID:35398189

Abstract

OBJECTIVES

The objective of the study was to quantify associations between cancer survival and antibiotic exposure before systemic anticancer therapy.

STUDY DESIGN AND SETTING

This population-based cohort study compares cause-specific survival according to antibiotic exposure before non-immune checkpoint inhibitor (ICI) systemic therapy in patients diagnosed with single primary cancers in New South Wales between 2013 and 2016. Proportional hazards regression was used to control for confounding, with no antibiotic exposure in the six months before non-ICI systemic therapy serving as the comparator.

RESULTS

After adjusting for tumour spread, cancer site, age, sex and comorbidity, people having antibiotic exposure within 180 days before non-ICI systemic therapy had poorer cancer survival (hazard ratios ranging from 1.21 [95% confidence interval: 1.06-1.39] to 1.58 [1.34-1.87]) for shorter periods since antibiotic exposure (P < .0001). Similarly, poorer survival trends applied for localized and metastatic cancer. Of six prevalent cancers studied, lung and breast primaries showed the strongest associations of lower survival with prior antibiotic exposure.

CONCLUSION

Antibiotic exposure within 180 days before non-ICI systemic cancer treatment is associated with poorer survival. If confirmed in other studies, it provides another reason for vigilant antibiotic stewardship.

摘要

目的

本研究的目的是量化全身抗癌治疗前癌症生存率与抗生素暴露之间的关联。

研究设计与背景

这项基于人群的队列研究比较了2013年至2016年在新南威尔士州被诊断为单一原发性癌症的患者在接受非免疫检查点抑制剂（ICI）全身治疗前根据抗生素暴露情况的特定病因生存率。采用比例风险回归来控制混杂因素，以非ICI全身治疗前六个月内未使用抗生素作为对照。

结果

在调整肿瘤扩散、癌症部位、年龄、性别和合并症后，在非ICI全身治疗前180天内使用过抗生素的患者，自抗生素暴露以来较短时间内的癌症生存率较差（风险比范围为1.21[95%置信区间：1.06 - 1.39]至1.58[1.34 - 1.87]）（P <.0001）。同样，局部和转移性癌症也存在较差的生存趋势。在所研究的六种常见癌症中，肺癌和乳腺癌原发性患者显示出先前抗生素暴露与较低生存率之间的最强关联。