Antibiotic Use Linked to Worse Outcomes in Patients With Gastrointestinal and Liver Cancer on Immune Checkpoint Inhibitors: A Meta-Analysis.

However, antibiotic-induced gut microbiota disruption may influence ICI effectiveness.

然而，抗生素引起的肠道微生物群失调可能会影响免疫检查点抑制剂（ICIs）的有效性。

The objective of this study was to evaluate association between antibiotic use and clinical outcomes among patients with gastrointestinal and liver cancers receiving ICI therapy.

本研究的目的是评估抗生素使用与接受免疫检查点抑制剂（ICIs）治疗的胃肠道和肝脏癌症患者临床结果之间的关联。

Methods

In this meta-analysis, we searched studies involving adults with gastrointestinal or liver cancers treated with ICIs, comparing outcomes between patients with and without antibiotic use.

在这项荟萃分析中，我们搜索了涉及接受免疫检查点抑制剂（ICIs）治疗的胃肠道或肝脏癌症成人患者的研究，比较了有无抗生素使用患者的结局。

Eligible studies reported hazard ratios (HRs) or odds ratios (ORs) with 95% confidence intervals (CIs) for overall survival(OS), progression-free survival(PFS), objective response rate, or disease control rate.

合格的研究报告了总生存期（OS）、无进展生存期（PFS）、客观反应率或疾病控制率的危险比（HRs）或比值比（ORs）及其95%置信区间（CIs）。

Random-effects models were used for pooled analyses.

随机效应模型用于汇总分析。

Results

Twenty-eight studies were included.

共有28项研究被纳入。

Antibiotic use was associated with worse OS (HR 1.56; 95% CI: 1.23-1.98; I2 = 87.3%), PFS (HR 1.48; 95% CI: 1.15-1.90; I2 = 88.3%), and disease control rate (OR 0.55; 95% CI: 0.33-0.90; I2 = 65.0%), but no significant difference in objective response rate(OR 1.01; 95% CI: 0.78-1.31; I2 = 0%).

抗生素使用与较差的总生存期（OS）（HR 1.56; 95% CI: 1.23-1.98; I2 = 87.3%）、无进展生存期（PFS）（HR 1.48; 95% CI: 1.15-1.90; I2 = 88.3%）和疾病控制率（OR 0.55; 95% CI: 0.33-0.90; I2 = 65.0%）相关，但在客观反应率上没有显著差异（OR 1.01; 95% CI: 0.78-1.31; I2 = 0%）。

Results were consistent in subgroup analyses by ICI type and timing of antibiotic administration.

在按ICI类型和抗生素给药时间进行的亚组分析中，结果是一致的。

Antibiotic use was associated with worse OS and PFS in hepatocellular carcinoma (HR for OS: 1.49; 95% CI: 1.24-1.79; HR for PFS: 1.25; 95% CI: 1.01-1.56) and upper gastrointestinal cancers (HR for OS: 2.40; 95% CI: 1.48-3.90; HR for PFS: 2.15; 95% CI: 1.18-3.91), whereas colorectal cancer studies showed improved OS (HR: 0.58; 95% CI: 0.45-0.75).

抗生素使用与肝细胞癌（OS的HR为1.49；95% CI：1.24-1.79；PFS的HR为1.25；95% CI：1.01-1.56）和上消化道癌症（OS的HR为2.40；95% CI：1.48-3.90；PFS的HR为2.15；95% CI：1.18-3.91）的总生存期（OS）和无进展生存期（PFS）较差相关，而结直肠癌研究显示OS改善（HR：0.58；95% CI：0.45-0.75）。

Discussion

Antibiotic use is associated with worse outcomes in patients with gastrointestinal or liver cancer receiving ICIs and should be carefully justified.

在接受ICI治疗的胃肠道或肝癌患者中，抗生素使用与更差的治疗结果相关，应谨慎合理使用。

Prospective studies are needed to validate these results.

需要前瞻性研究来验证这些结果。