抗生素对接受免疫检查点抑制剂治疗的晚期食管癌患者预后的影响

Effect of antibiotics on the prognosis of advanced esophageal cancer patients receiving immune checkpoint inhibitors

目的探讨抗生素对应用免疫检查点抑制剂(ICIs)治疗晚期食管癌患者疗效的影响。方法回顾性分析2020年1月—2022年9月在徐州医科大学附属医院接受ICIs治疗的晚期食管癌患者的临床资料。根据抗生素使用情况,将入组患者分为抗生素组与非抗生素组,并对患者的生存情况进行随访。结果共纳入136例晚期食管癌患者,使用抗生素65例,未使用抗生素71例,2组临床特征如性别、年龄、临床分期等差异均无统计学意义(P>0.05);抗生素组患者中位总生存期(mOS)与中位无进展生存期(mPFS)均缩短(P<0.05);多因素分析显示治疗方案是影响患者预后的独立危险因素。亚组分析表明喹诺酮类和氨基糖苷类药物对使用抗生素患者mOS与mPFS无明显影响(P>0.05),而β-内酰胺类药物可缩短使用抗生素患者的mOS和mPFS(P<0.05)。结论抗生素影响ICIs的疗效,不同类型抗生素对临床结果的影响不同。正在接受或计划接受ICIs的晚期食管癌患者,应避免使用β-内酰胺类抗生素。

Objective To explore the effect of antibiotics on advanced esophageal cancer patients receiving immune checkpoint inhibitors(ICIs).Methods The clinical data of advanced esophageal cancer patients who received ICIs from January 2020 to September 2022 in the Affiliated Hospital of Xuzhou Medical University were retrospectively analyzed.According to the use of antibiotics,the patients were divided into two groups:an antibiotic group and a non-antibiotic group,and their survival was follow-up visited.Results A total of 136 advanced esophageal cancer patients were included in the study,including 65 patients in the antibiotic group and 71 in the non-antibiotic group.There were no statistical differences in gender,age,and clinical stage between the two groups(P<0.05).However,patients treated with antibiotics showed shortened median overall survival(mOS)and median progression-free survival(mPFS)(P<0.05).Multivariate analysis indicated that treatment scheme was an independent risk factor for prognosis.According to subgroup analysis,quinolones and aminoglycosides did not exhibit remarkable effect on mOS and mPFS(P>0.05),while β-lactams shortened mOS and mPFS in patients(P<0.05).Conclusions Antibiotics can affect the efficacy of ICIs.Different types of antibiotics exhibit various effect on clinical outcomes.Furthermore,β-lactams should be avoided in patients with advanced esophageal cancer who are undergoing or planning to undergo ICIs.