Antibiotic Therapy and Risk of Early-Onset Colorectal Cancer: A National Case-Control Study.
Antibiotic Therapy and Risk of Early-Onset Colorectal Cancer: A National Case-Control Study.
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DOI：
10.14309/ctg.0000000000000437
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发表时间：
2022-01-13
影响因子：
3.6
通讯作者：
Ludvigsson JF
中科院分区：
文献类型：
--
作者：
Nguyen LH;Cao Y;Batyrbekova N;Roelstraete B;Ma W;Khalili H;Song M;Chan AT;Ludvigsson JF
抗生素的使用已成为结直肠癌的危险因素，并被认为是50岁以下结直肠癌或早发性结直肠癌(EOCRC)发病率上升的原因之一。然而，抗生素使用的影响和EOCRC的风险尚不清楚。我们在瑞典(意式咖啡)队列(2006年至2016年)组织病理学报告加强的流行病学中，在18岁的≥人群中进行了一项基于人群的结直肠癌病例对照研究。主要结果是EOCRC。次要结果是任何年龄段的CRC。发生结直肠癌事件经病理证实，每个病例最多有5个基于人群的对照在年龄、性别、居住地和日历年上匹配。我们评估处方直到结直肠癌诊断前6个月。条件Logistic回归用于估计调整后的优势比(AORS)和95%可信区间(CI)。我们确定了54,804例结直肠癌(2,557例EOCR)和261,089例对照。与不使用抗生素相比，在调整潜在混杂因素(AOR 1.06，95%CI：0.96，1.17)后，既往使用抗生素与EOCRC风险无关，按解剖肿瘤部位分层后发现类似的无效结果。相反，以前使用抗生素与任何年龄段的结直肠癌风险升高的相关性较弱(AOR 1.05，95%CI：1.02，1.07)。观察到广谱抗生素的使用与EOCRC之间存在潜在但温和的联系(AOR 1.13，95%CI：1.02，1.26)。我们没有发现确凿的证据表明抗生素与EOCRC风险有关。尽管抗生素的使用与任何年龄段的结直肠癌风险的相关性都很弱，但相关性的大小并不大，研究周期也相对较短。
Antibiotic use has emerged as a risk factor for colorectal neoplasia and is hypothesized as a contributor to the rising incidence of colorectal cancer under age 50 years or early-onset colorectal cancer (EOCRC). However, the impact of antibiotic use and risk of EOCRC is unknown. We conducted a population-based case-control study of CRC among individuals aged ≥18 years in the Epidemiology Strengthened by histoPathology Reports in Sweden (ESPRESSO) cohort (2006–2016). The primary outcome was EOCRC. A secondary outcome was CRC at any age. Incident CRC was pathologically confirmed, and for each, up to 5 population-based controls were matched on age, sex, county of residence, and calendar year. We assessed prescriptions until 6 months before CRC diagnosis. Conditional logistic regression was used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs). We identified 54,804 cases of CRC (2,557 EOCRCs) and 261,089 controls. Compared with none, previous antibiotic use was not associated with EOCRC risk after adjustment for potential confounders (aOR 1.06, 95% CI: 0.96, 1.17) with similarly null findings when stratified by anatomic tumor site. In contrast, previous antibiotic use was weakly associated with elevated risk for CRC at any age (aOR 1.05, 95% CI: 1.02, 1.07). A potential but modest link between broad-spectrum antibiotic use and EOCRC was observed (aOR 1.13, 95% CI: 1.02, 1.26). We found no conclusive evidence that antibiotics are associated with EOCRC risk. Although antibiotic use was weakly associated with risk of CRC at any age, the magnitude of association was modest, and the study period was relatively short.