Antibiotic Usage During Surgery may be Correlated With Survival in Radically Resected Non-Small-Cell Lung Cancer Patients

Abstract

Background: Accumulating evidence suggests that the use of antibiotics (ATBs) is harmful to the survival of patients with non-small-cell lung cancer (NSCLC). However, the association between the prophylactic use of these agents during surgery and patient survival has been less well studied.

Methods: Data concerning the use of ATBs, including the cumulative defined daily dose (cDDD) and type, in stage I to III NSCLC patients were collected. The patients were subsequently divided into low or high-cDDD subgroups and ⩽2 or ⩾3 ATB-type subgroups. Differences in clinical variables, overall survival (OS), and disease-free survival (DFS) among these groups were assessed. Furthermore, differences in survival among specific ATB types (β-lactams and fluoroquinolones) were also tested. Finally, the risk factors for OS were determined using the Cox proportional hazards model.

Results: A total of 324 patients were included. Low cDDD was more common in patients with advanced T stages, whereas ⩽2 types of ATBs were common in female patients and those with adenocarcinoma, N₀ disease and stage I disease. No significant difference was found in OS among the low- or high-cDDD subgroups; however, a significant difference in OS was found between the ⩽2 and ⩾3 ATB. Similarly, patients with or without β-lactams displayed no difference in OS, whereas those with or without fluoroquinolones did. No differences were found in DFS between the subgroups. Multiple types of ATBs, rather than cDDD, were found to be risk factors for OS; however, they were not validated as independent risk factors.

Conclusions: This study, for the first time, explored the prognostic value of ATB use during surgery in NSCLC patients and revealed that multiple types of ATBs may be associated with OS in patients with stage I to III disease. Notably, patients treated with fluoroquinolones may have inferior outcomes than those without ATB use. However, multiple types of ATBs were not validated as independent risk factors for OS. These results suggest that the use of ATBs during surgery in early-stage NSCLC is generally safe; however, caution should be taken when selecting ATB types. Multiple ATB types should be avoided, and some specific ATB types, such as fluoroquinolones, should not be administered. Nonetheless, owing to the limited sample sizes, future studies are needed to validate our results.

Keywords: Lung cancer; antibiotic; fluoroquinolones; overall survival; surgery; β-lactams.

Figure 1.

Flow chart of the patient recruitment process.

Figure 2.

Differences in OS among different subgroups (n = 324). (A) No significant difference in OS was detected among the low- (n = 161) or high- (n = 163) cDDD subgroups. (B) A significant difference in OS was detected among the ⩽2- (n = 260) or ⩾3 (n = 64) ATB-type subgroups. (C) No significant difference in OS was detected among patients with (n = 306) or without (n = 18) β-lactams. (D) A significant difference in OS was detected among patients with (n = 124) or without (n = 200) fluoroquinolones. Abbreviations: cDDD, cumulative defined daily dose; OS, overall survival.

Figure 3.

DFS differences among different subgroups (n = 324). (A) No significant difference in DFS was detected among the low- (n = 161) or high- (n = 163) cDDD subgroups. (B) No significant difference in DFS was detected among the ⩽2- (n = 260) or ⩾3 (n = 64) ATB-type subgroups. (C) No significant difference in DFS was detected among patients with (n = 306) or without (n = 18) β-lactams. (D) No significant difference in DFS was detected among patients with (n = 124) or without (n = 200) fluoroquinolones. Abbreviations: cDDD, cumulative defined daily dose; DFS, disease-free survival.