Prediagnostic prescription antibiotics use and survival in colorectal cancer patients: A Swedish national register-based study.

Abstract

Antibiotics use is associated with higher colorectal cancer risk, but little is known regarding any potential effects on survival. We conducted a nationwide cohort study, using complete-population data from Swedish national registers between 2005 and 2020, to investigate prediagnostic prescription antibiotics use in relation to survival in colorectal cancer patients. We identified 36 061 stage I-III and 11 242 stage IV colorectal cancer cases diagnosed between 2010 and 2019. For stage I-III, any antibiotics use (binary yes/no variable) was not associated with overall or cancer-specific survival. Compared to no use, moderate antibiotics use (total 11-60 days) was associated with slightly better cancer-specific survival (adjusted hazard ratio (aHR) = 0.93, 95% confidence interval (CI) 0.86-0.99), whereas very high use (>180 days) was associated with worse survival (overall survival aHR = 1.42, 95% CI 1.26-1.60, cancer-specific survival aHR =1.31, 95% CI 1.10-1.55). In analyses by different antibiotic types, although not statistically significant, worse survival outcomes were generally observed across several antibiotics, particularly macrolides and/or lincosamides. In stage IV colorectal cancer, inverse relationships between antibiotics use and survival were noted. Overall, our findings do not support any substantial detrimental effects of prediagnostic prescription antibiotics use on cancer-specific survival after colorectal cancer diagnosis, with the possible exception of very high use in stage I-III colorectal cancer. Further investigation is warranted to confirm and understand these results. Although the study findings require confirmation, physicians probably do not need to factor in prediagnostic prescription antibiotics use in prognosticating colorectal cancer patients.