Department of Thoracic Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, PR.China.
Department of Oncology, Chengdu Jinniu District People's Hospital, Chengdu, PR.China.
Cancer Med. 2022 Dec;11(24):4849-4864. doi: 10.1002/cam4.4815. Epub 2022 May 11.
To determine whether antibiotic use before chemotherapy is associated with chemotherapy responses and patient outcomes among NSCLC patients and define the optimal interval between chemotherapy initiation and antibiotic treatment.
One thousand four hundred and four advanced NSCLC patients receiving first-line platinum-based doublets therapy were retrospectively analyzed. Kaplan-Meier curve evaluated the impact of antibiotic use and type of antibiotics on the survival of patients. The factors affect the patient's prognosis were further confirmed by Cox regression. The optimal interval between antibiotic treatment and the initiation of chemotherapy was determined by the X-tile program.
NSCLC patients of 33.5% advanced underwent broad-spectrum antibiotic treatment prior to chemotherapy. In the chemotherapy only (Chemo) and chemotherapy plus antiangiogenesis (Chemo-angio) treatment groups, prior antibiotic treatment was associated with worse OS (Chemo: 13.8 vs. 17.6 months, p < 0.001; Chemo-angio:11.9 vs. 18.1 months, p = 0.012) and PFS (Chemo: 3.7 vs. 5.8 months, p < 0.001; Chemo-angio: 3.1 vs. 5.9 months, p < 0.001). Cox regression analysis revealed prior antibiotic administration as an independent predictor of OS and PFS (HR for PFS/OS: 1.925/1.452, both p < 0.001). Antibiotic usage duration (HR for PFS/OS: 1.030/1.036, p = 0.009/0.001) and type (PFS/OS: p < 0.001/p = 0.01) also showed significant association with patient prognosis, with calculated interval time cutoff values of 2, 4, and 2 days for fluoroquinolones, β-lactamase inhibitors, and cephalosporins, respectively.
Antibiotic use before first-line chemotherapy was associated with poor results in advanced NSCLC patients; treatment length and type being strongly correlated with patient outcomes. Appropriate prolongation of the time between two treatments may enhance patient survival. Further prospective research is however necessary.
本研究旨在探讨化疗前使用抗生素是否与非小细胞肺癌（NSCLC）患者的化疗反应和患者结局相关，并确定化疗开始与抗生素治疗之间的最佳间隔时间。
本研究回顾性分析了 1404 例接受一线含铂双药化疗的晚期 NSCLC 患者。Kaplan-Meier 曲线评估了抗生素使用和抗生素类型对患者生存的影响。进一步通过 Cox 回归分析确定影响患者预后的因素。通过 X-tile 程序确定抗生素治疗与化疗开始之间的最佳间隔时间。
33.5%的晚期 NSCLC 患者在化疗前接受了广谱抗生素治疗。在仅化疗（Chemo）和化疗联合抗血管生成治疗（Chemo-angio）组中，化疗前使用抗生素与较差的总生存期（OS）（Chemo：13.8 与 17.6 个月，p<0.001；Chemo-angio：11.9 与 18.1 个月，p=0.012）和无进展生存期（PFS）（Chemo：3.7 与 5.8 个月，p<0.001；Chemo-angio：3.1 与 5.9 个月，p<0.001）相关。Cox 回归分析显示，化疗前使用抗生素是 OS 和 PFS 的独立预测因素（PFS/OS 的 HR：1.925/1.452，均 p<0.001）。抗生素使用持续时间（PFS/OS 的 HR：1.030/1.036，p=0.009/0.001）和类型（PFS/OS：p<0.001/p=0.01）也与患者预后显著相关，氟喹诺酮类、β-内酰胺酶抑制剂和头孢菌素的计算间隔时间截断值分别为 2、4 和 2 天。
一线化疗前使用抗生素与晚期 NSCLC 患者的不良结果相关；抗生素使用时间和类型与患者结局密切相关。适当延长两次治疗之间的时间可能会提高患者的生存率。然而，仍需要进一步的前瞻性研究。
