Domzaridou Eleni, Van Staa Tjeerd, Renehan Andrew G, Cook Natalie, Welfare William, Ashcroft Darren M, Palin Victoria
National Institute for Health and Care Research Greater Manchester Patient Safety Research Collaboration, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK.
Centre for Health Informatics, Division of Informatics, Imaging and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK.
Curr Oncol. 2023 Sep 15;30(9):8434-8443. doi: 10.3390/curroncol30090614.
There is limited evidence in humans as to whether antibiotics impact the effectiveness of cancer treatments. Rodent studies have shown that disruption in gut microbiota due to antibiotics decreases cancer therapy effectiveness. We evaluated the associations between the antibiotic treatment of different time periods before cancer diagnoses and long-term mortality.
Using the Clinical Practice Research Datalink GOLD, linked to the Cancer Registry's and the Office for National Statistics' mortality records, we delineated a study cohort that involved cancer patients who were prescribed antibiotics 0-3 months; 3-24 months; or more than 24 months before cancer diagnosis. Patients' exposure to antibiotics was compared according to the recency of prescriptions and time-to-event (all-cause mortality) by applying Cox models.
111,260 cancer patients from England were included in the analysis. Compared with antibiotic prescriptions that were issued in the past, patients who had been prescribed antibiotics shortly before cancer diagnosis presented an increased hazard ratio (HR) for mortality. For leukaemia, the HR in the Cancer Registry was 1.32 (95% CI 1.16-1.51), for lymphoma it was 1.22 (1.08-1.36), for melanoma it was 1.28 (1.10-1.49), and for myeloma it was 1.19 (1.04-1.36). Increased HRs were observed for cancer of the uterus, bladder, and breast and ovarian and colorectal cancer.
Antibiotics that had been issued within the three months prior to cancer diagnosis may reduce the effectiveness of chemotherapy and immunotherapy. Judicious antibiotic prescribing is needed among cancer patients.
关于抗生素是否会影响癌症治疗效果，在人体中的证据有限。啮齿动物研究表明，抗生素导致的肠道微生物群紊乱会降低癌症治疗效果。我们评估了癌症诊断前不同时间段的抗生素治疗与长期死亡率之间的关联。
利用与癌症登记处和国家统计局死亡率记录相链接的临床实践研究数据链黄金数据库，我们划定了一个研究队列，其中包括在癌症诊断前0至3个月、3至24个月或超过24个月开具抗生素处方的癌症患者。通过应用Cox模型，根据处方的近期性和事件发生时间（全因死亡率）比较患者接触抗生素的情况。
来自英国的111260名癌症患者被纳入分析。与过去开具的抗生素处方相比，在癌症诊断前不久开具抗生素处方的患者死亡率风险比（HR）增加。对于白血病，癌症登记处的HR为1.32（95%CI 1.16-1.51），淋巴瘤为1.22（1.08-1.36），黑色素瘤为1.28（1.10-1.49），骨髓瘤为1.19（1.04-1.36）。子宫癌、膀胱癌、乳腺癌、卵巢癌和结直肠癌的HR也有所增加。
在癌症诊断前三个月内开具的抗生素可能会降低化疗和免疫治疗的效果。癌症患者需要谨慎开具抗生素处方。
