School of Medicine, UT Southwestern Medical Center.
Department of Internal Medicine (Division of Hematology-Oncology), UT Southwestern Medical Center; Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center.
Clin Lung Cancer. 2023 Jan;24(1):11-17. doi: 10.1016/j.cllc.2022.09.005. Epub 2022 Sep 24.
Antibiotic exposure is associated with worse clinical outcomes in patients receiving immune checkpoint inhibitors (ICI). We analyzed antibiotic prescription patterns in lung cancer and melanoma, two malignancies in which ICI are used broadly across stages.
We performed a retrospective cohort study of adults in the U.S. Veterans Affairs (VA) medical system diagnosed with lung cancer or melanoma from 2003 to 2016. We defined antibiotic exposure as receipt of a prescription for a systemic antibacterial agent between 6 months before and 6 months after cancer diagnosis. Demographics, clinical variables, prescriptions, and diagnostic codes were abstracted from the VA Corporate Data Warehouse. Antibiotic exposure was compared using t tests, Chi-square, and multivariate analyses.
A total of 310,321 patients (280,068 lung cancer, 30,253 melanoma) were included in the analysis. Antibiotic exposure was more common among patients with lung cancer (42% vs. 24% for melanoma; P < .001). Among antibiotic-exposed patients, those with lung cancer were more likely to receive prescriptions for multiple antibiotics (47% vs. 30% for melanoma; P < .001). In multivariate analyses, antibiotic exposure was associated with lung cancer diagnosis (HR 1.50; 95% CI, 1.46-1.55), comorbidity score (HR 1.08; 95% CI, 1.08-1.09), non-white race (HR 1.11; 95% CI, 1.06-1.17), and female gender (HR 1.31; 95% CI, 1.24-1.37).
Among cancer patients, antibiotics are prescribed frequently. Antibiotic exposure is more common in certain cancer types and patient populations. Given the negative effect antibiotic exposure has on immunotherapy outcomes, these observations may have clinical and healthy policy implications.
抗生素暴露与接受免疫检查点抑制剂（ICI）治疗的患者的临床结局恶化有关。我们分析了肺癌和黑色素瘤患者的抗生素处方模式，这两种癌症在各阶段都广泛使用 ICI。
我们对美国退伍军人事务部（VA）医疗系统中 2003 年至 2016 年间诊断为肺癌或黑色素瘤的成年人进行了回顾性队列研究。我们将抗生素暴露定义为在癌症诊断前 6 个月至后 6 个月期间收到全身性抗菌药物处方。从 VA 公司数据仓库中提取人口统计学、临床变量、处方和诊断代码。使用 t 检验、卡方检验和多变量分析比较抗生素暴露情况。
共纳入 310321 例患者（280068 例肺癌，30253 例黑色素瘤）。肺癌患者的抗生素暴露更为常见（42%比黑色素瘤的 24%；P<0.001）。在接受抗生素治疗的患者中，肺癌患者更有可能接受多种抗生素处方（47%比黑色素瘤的 30%；P<0.001）。多变量分析显示，抗生素暴露与肺癌诊断相关（HR 1.50；95%CI，1.46-1.55），合并症评分（HR 1.08；95%CI，1.08-1.09），非白人种族（HR 1.11；95%CI，1.06-1.17）和女性性别（HR 1.31；95%CI，1.24-1.37）。
在癌症患者中，抗生素的处方非常常见。抗生素暴露在某些癌症类型和患者人群中更为常见。鉴于抗生素暴露对免疫治疗结局的负面影响，这些观察结果可能具有临床和公共卫生政策意义。
