化疗免疫疗法晚期 NSCLC 患者的抗生素使用与生存率

IF 3 Q2 ONCOLOGY

JTO Clinical and Research Reports Pub Date : 2024-07-31 DOI:10.1016/j.jtocrr.2024.100710

Emanuela Taioli MD, PhD , Raja M. Flores MD , Arwa Abdelhamid MPH , Matthew Untalan MPH , Tara Ivic-Pavlicic MPH , Stephanie Tuminello PhD, MPH

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引用次数: 0

摘要

导言免疫疗法提高了晚期 NSCLC 患者的生存率。可能由于肠道微生物组的破坏，患者接受抗生素治疗时疗效可能会下降，但很少有研究利用美国真实世界的患者群体对此进行调查。方法我们分析了2015年确诊的IV期初治NSCLC患者中使用抗生素的情况，这些患者接受了化疗或化学免疫疗法，数据来自监测、流行病学和最终结果-医疗保险数据集。患者必须连续参加 A 部分、B 部分和 D 部分医疗保险。生存率通过卡普兰-梅耶（Kaplan-Meier）和考克斯比例危险模型确定。所有数据分析均使用 SAS 进行。研究共纳入 788 名患者，其中 440 人（56%）在开始系统治疗前后 2 个月内接受了抗生素治疗。中位随访时间为 11.64 个月。接受过抗生素治疗的患者（p = 0.007）与接受过一轮以上抗生素治疗的患者（p <0.0001）在生存率上有显著统计学差异。经调整后，接受抗生素治疗（危险比[HR]adj：1.17，95% 置信区间[CI]：0.99-1.37）和接受多轮抗生素治疗（HRadj：1.35，95% 置信区间[CI]：1.14-1.60）在统计学上与较差的生存率显著相关。仅在接受化学免疫疗法的患者（n = 203；26%）中，接受多轮抗生素治疗的患者死亡风险仍然增加（HRadj：1.52，95% CI：1.09-2.13）。结论化疗免疫疗法同时使用抗生素似乎与生存率降低有关，当使用抗生素的周期越多，生存率越低。

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Antibiotic Use and Survival in Patients With Late-Stage NSCLC Treated With Chemoimmunotherapy

Introduction

Immunotherapy has improved survival in patients with advanced NSCLC. Efficacy may decrease when patients are treated with antibiotics, possibly due to gut microbiome disruption, but few studies have investigated this using real-world, patient-level populations in the United States.

Methods

We have analyzed antibiotic use in patients with stage IV first, primary NSCLC diagnosed in 2015 and treated with chemotherapy or chemoimmunotherapy, drawn from the Surveillance, Epidemiology, and End Results-Medicare data set. Patients had to have continuous part A, part B, and part D Medicare coverage. Survival was determined through Kaplan-Meier and Cox proportional hazards models. All data analyses were performed using SAS.

Results

The study included 788 patients, 440 (56%) of whom received antibiotics within 2 months before or after starting systemic treatment. The median follow-up time was 11.64 months. There was a statistically significant difference in survival for patients who received antibiotics (p = 0.007) and who had more than 1 round of antibiotics versus zero or 1 round (p < 0.0001). After adjustment, receipt of antibiotics (hazard ratio [HR]_adj: 1.17, 95% confidence interval [CI]: 0.99–1.37) and receipt of multiple rounds of antibiotics (HR_adj: 1.35, 95% CI: 1.14–1.60) were statistically significantly associated with worse survival. Among just those receiving chemoimmunotherapy (n = 203; 26%), there was still an increased risk of death for those receiving multiple antibiotic rounds (HR_adj: 1.52, 95% CI: 1.09–2.13).

Conclusions

Antibiotic use concurrent with chemoimmunotherapy seems to be associated with worse survival. This is more pronounced when more cycles of antibiotics are given.