Zhang Fangyuan, Ding Zixuan, Lian Yongping, Yang Xiao, Hu Pengbo, Liu Yongqing, Xu Liang, Li Zhou, Qiu Hong
Department of Oncology, Tongji Hospital Affiliated to Tongji Medical College of Huazhong, University of Science and Technology, Wuhan 430000, Hubei, China.
The First School of Clinical Medicine, Lanzhou University, Lanzhou, 730000, China.
Oncologist. 2025 Feb 6;30(2). doi: 10.1093/oncolo/oyae362.
The relationship between antibiotic treatment and immunotherapy efficacy is complex.
This study was a single-center study. History of antibiotic use in gastric cancer (GC) patients within 1 or 3 months prior to immunotherapy was collected. Patients were categorized into 3 groups according to whether they had used antibiotics prior to immunotherapy: none, prophylactic use, and infection.
A total of 252 GC patients received immunotherapy, of which 38.5% (97/252) received antibiotic treatment within 1 month before immunotherapy (prophylactic use in 72.2% of patients) and 48.8% (123/252) received antibiotic treatment within 3 months before immunotherapy (prophylactic use in 74.8% of patients). The prophylactic use of antibiotic within 1 month prior to immunotherapy significantly improved overall survival (OS) compared with patients who received anti-infective therapy and had no history of antibiotic use (prophylactic vs infection: OS, 22.6 vs 9.7 m, HR, 0.53, 95% CI, 0.27-1.07; prophylactic vs none: OS, 22.6 vs 14.7 m, HR, 0.57; 95% CI, 0.39-0.83). The use of antibiotics in infected patients did not increase the risk of death in patients compared with those who did not use antibiotics. Prophylactic antibiotic use within 1 month before immunotherapy is an independent prognostic factor for OS.
Prophylactic use of antibiotics is associated with better prognosis in GC patients receiving immunotherapy. Therefore, there is no necessity to delay the use of immune checkpoint inhibitors in this group of patients.
抗生素治疗与免疫治疗疗效之间的关系较为复杂。
本研究为单中心研究。收集了胃癌（GC）患者在免疫治疗前1个月或3个月内的抗生素使用史。根据免疫治疗前是否使用过抗生素，将患者分为3组：未使用、预防性使用和感染。
共有252例GC患者接受了免疫治疗，其中38.5%（97/252）在免疫治疗前1个月内接受了抗生素治疗（72.2%的患者为预防性使用），48.8%（123/252）在免疫治疗前3个月内接受了抗生素治疗（74.8%的患者为预防性使用）。与接受抗感染治疗且无抗生素使用史的患者相比，免疫治疗前1个月内预防性使用抗生素显著改善了总生存期（OS）（预防性使用与感染：OS，22.6对9.7个月，HR，0.53，95%CI，0.27 - 1.07；预防性使用与未使用：OS，22.6对14.7个月，HR，0.57；95%CI，0.39 - 0.83）。感染患者使用抗生素与未使用抗生素的患者相比，并未增加死亡风险。免疫治疗前1个月内预防性使用抗生素是OS的独立预后因素。
预防性使用抗生素与接受免疫治疗的GC患者预后较好相关。因此，对于这组患者没有必要延迟使用免疫检查点抑制剂。
