免疫检查点抑制剂治疗前抗生素使用时长对复发性妇科恶性肿瘤患者总生存期的不良影响
Adverse Effect of the Duration of Antibiotic Use Prior to Immune Checkpoint Inhibitors on the Overall Survival of Patients with Recurrent Gynecologic Malignancies.
作者信息
Jung Hye-Ji, Park Jong-Ho, Oh Jina, Lee Sae-Mi, Jang Il-Yeo, Hong Jung-Yong, Lee Yoo-Young, Choi Hyun Jin
机构信息
Gynecologic Cancer Center, Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea.
Chung-Ang University College of Medicine, Seoul 06974, Republic of Korea.
出版信息
Cancers (Basel). 2023 Dec 7;15(24):5745. doi: 10.3390/cancers15245745.
PURPOSE
Antibiotic use preceding immune checkpoint inhibitor (ICI) treatment has been associated with a decreased efficacy of ICI in solid tumors. In this study, we evaluated the effect of antibiotic use before ICI therapy on oncological outcomes.
METHODS
We examined patients with recurrent gynecologic malignancies at two academic institutions. The clinical data, including antibiotic use within 60 days of ICI initiation, type of antibiotics, reasons for antibiotic use, body mass index, tumor site, chemotherapy-free interval, prior history of radiotherapy, disease control rate (DCR), and overall survival (OS), were assessed.
RESULTS
Of 215 patients, 22.9% ( = 47) received antibiotics before ICI treatment. The most common cancer was ovarian (52.1%, = 112), followed by cervical (24.7%, = 53) and endometrial (16.7%, = 36). When we divided the cohort based on antibiotic use before ICIs, there were no significant differences in the DCR and baseline characteristics between the two groups. On multivariate analyses, the variables associated with poor OS were previous use of antibiotics for a cumulative duration of >14 days (HR 2.286, 95% CI 1.210-4.318; = 0.011); Eastern Cooperative Oncology Group 2 or 3 (HR 4.677, 95% CI 2.497-8.762; < 0.001); and chemotherapy-free interval of <6 months (HR 2.007, 95% CI 1.055-3.819; = 0.034).
CONCLUSION
Prior use of antibiotics for a cumulative duration of >14 days was associated with reduced survival in recurrent gynecologic malignancies.
目的
免疫检查点抑制剂（ICI）治疗前使用抗生素与实体瘤中ICI疗效降低有关。在本研究中，我们评估了ICI治疗前使用抗生素对肿瘤学结局的影响。
方法
我们在两家学术机构检查了复发性妇科恶性肿瘤患者。评估了临床数据，包括ICI开始前60天内使用抗生素的情况、抗生素类型、使用抗生素的原因、体重指数、肿瘤部位、无化疗间期、既往放疗史、疾病控制率（DCR）和总生存期（OS）。
结果
215例患者中，22.9%（n = 47）在ICI治疗前接受了抗生素治疗。最常见的癌症是卵巢癌（52.1%，n = 112），其次是宫颈癌（24.7%，n = 53）和子宫内膜癌（16.7%，n = 36）。当我们根据ICI治疗前是否使用抗生素对队列进行划分时，两组之间的DCR和基线特征没有显著差异。多因素分析显示，与OS较差相关的变量包括既往使用抗生素累计时间>14天（HR 2.286，95%CI 1.210 - 4.318；P = 0.011）；东部肿瘤协作组（ECOG）评分为2或3（HR 4.677，95%CI 2.497 - 8.762；P < 0.001）；以及无化疗间期<6个月（HR 2.007，95%CI 1.055 - 3.819；P = 0.034）。
结论
既往使用抗生素累计时间>14天与复发性妇科恶性肿瘤患者生存率降低有关。
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