成年后口服抗生素与早发结直肠癌的风险:病例对照研究

IF 11.6 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Clinical Gastroenterology and Hepatology Pub Date : 2024-10-03 DOI:10.1016/j.cgh.2024.09.002
Kevin J Kane, Christopher D Jensen, Jingrong Yang, Huyun Dong, Sophie A Merchant, Pradeep Koripella, Xiaoran Li, Jeffrey M Hendel, Douglas A Corley, Jeffrey K Lee
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引用次数: 0

摘要

背景与目的:50 岁以下人群的结直肠癌(早发结直肠癌 [EOCRC])发病率不断上升,之前使用抗生素可能是其中的一个因素;然而,对这一联系进行研究的少数几项研究报告了相互矛盾的结果。因此,我们在美国的一个大型综合医疗系统中评估了成年后口服抗生素与 EOCRC 之间的关联:方法:我们对 1998-2020 年间被诊断为 EOCRC(结肠或直肠腺癌)的 18-49 岁北加州凯泽医疗集团患者进行了一项基于人群的巢式病例对照研究,这些患者在确诊前有≥2 年的连续药房福利。病例与健康对照组在出生年份、性别、种族和民族、医疗机构和药房福利持续时间方面的匹配比例为 4:1。根据处方记录对诊断/指标日期前一年以上的抗生素接触情况进行评估。条件逻辑回归用于估计几率比(OR)和 95% 置信区间(CI)。对连续处方记录≥10年的患者进行了敏感性分析:1359 例 EOCRC 病例与 4711 例健康对照组进行了配对。在未调整或调整后的分析中,成年期使用抗生素与 EOCRC 的关系不大(调整后 OR:1.04;95% CI:0.94-1.26)。口服抗生素的累计配药次数或之前接触抗生素的任何时期均与此无关联:在美国的大型医疗机构中,没有确凿证据表明成年后口服抗生素与罹患 EOCRC 的风险有关。
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Oral Antibiotic Use in Adulthood and Risk of Early-Onset Colorectal Cancer: A Case-Control Study.

Background and aims: Prior antibiotic use may be a factor in the rising incidence of colorectal cancer seen in those under 50 years of age (early-onset colorectal cancer [EOCRC]); however, the few studies to examine this link have reported conflicting results. Therefore, we evaluated the association between oral antibiotic use in adulthood and EOCRC in a large integrated healthcare system in the United States.

Methods: A population-based nested case-control study was conducted among Kaiser Permanente Northern California patients 18-49 years of age diagnosed with EOCRC (adenocarcinoma of the colon or rectum) in 1998-2020 who had ≥2 years of continuous pharmacy benefit prior to diagnosis. Cases were matched 4:1 to healthy controls on birth year, sex, race and ethnicity, medical facility, and duration of pharmacy benefit. Antibiotic exposure >1 year before the diagnosis/index date was assessed using prescribing records. Conditional logistic regression was used to estimate odds ratios and 95% confidence intervals. A sensitivity analysis was performed among those with ≥10 years of continuous prescribing records.

Results: A total of 1359 EOCRC cases were matched to 4711 healthy controls. Antibiotic use in adulthood was not significantly associated with EOCRC in unadjusted or adjusted analyses (adjusted odds ratio, 1.04; 95% confidence interval, 0.94-1.26). No associations were seen for cumulative number of oral antibiotic dispensations or for any prior period of antibiotic exposure.

Conclusions: In a large U.S. healthcare setting, there was no conclusive evidence of an association between oral antibiotic use in adulthood and risk of EOCRC.

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来源期刊
CiteScore
16.90
自引率
4.80%
发文量
903
审稿时长
22 days
期刊介绍: Clinical Gastroenterology and Hepatology (CGH) is dedicated to offering readers a comprehensive exploration of themes in clinical gastroenterology and hepatology. Encompassing diagnostic, endoscopic, interventional, and therapeutic advances, the journal covers areas such as cancer, inflammatory diseases, functional gastrointestinal disorders, nutrition, absorption, and secretion. As a peer-reviewed publication, CGH features original articles and scholarly reviews, ensuring immediate relevance to the practice of gastroenterology and hepatology. Beyond peer-reviewed content, the journal includes invited key reviews and articles on endoscopy/practice-based technology, health-care policy, and practice management. Multimedia elements, including images, video abstracts, and podcasts, enhance the reader's experience. CGH remains actively engaged with its audience through updates and commentary shared via platforms such as Facebook and Twitter.
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