Impact of Peri-Immunotherapy Antibiotic Exposure on Survival Outcomes in Metastatic Renal Cell Carcinoma: A Real-World IMDC Risk–Stratified Analysis
Journal of Clinical Medicine, cilt.15, sa.5, 2026 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 15 Sayı: 5
- Basım Tarihi: 2026
- Doi Numarası: 10.3390/jcm15051853
- Dergi Adı: Journal of Clinical Medicine
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Chemical Abstracts Core, EMBASE, Academic Search Ultimate (EBSCO), Health Research Premium Collection (ProQuest)
- Anahtar Kelimeler: renal cell carcinoma, immune checkpoint inhibitors, antibiotic exposure, gut microbiota, dysbiosis, IMDC risk classification, progression-free survival, overall survival
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Background: Antibiotic exposure has been shown to negatively affect immune checkpoint inhibitor (ICI) efficacy in several cancers, possibly by disrupting gut microbiota. It represents a potentially modifiable clinical factor that may influence immunotherapy efficacy in RCC. However, data on renal cell carcinoma (RCC) remain limited, especially regarding prognostic risk groups. Methods: We conducted a retrospective cohort study of 120 RCC patients treated with ICIs between 2018 and 2024 at Kartal Dr. Lütfi Kırdar City Hospital. Patients were classified based on systemic antibiotic exposure within ±30 days of ICI start. Survival outcomes were compared using Kaplan–Meier and Cox regression analyses. Subgroup analyses were performed according to the International Metastatic RCC Database Consortium (IMDC) risk classification. Results: Of the 120 patients, 38 (31.7%) received antibiotics during the peri-ICI period. Median progression-free survival (PFS) was significantly shorter in the antibiotic-exposed group (5.1 vs. 9.4 months; p = 0.004), as was overall survival (OS) (14.8 vs. 22.5 months; p = 0.03). Antibiotic use remained an independent predictor of both PFS (HR = 1.87; 95% CI: 1.21–2.89) and OS (HR = 1.64; 95% CI: 1.04–2.59). In subgroup analyses, intermediate-risk patients had worse OS with antibiotics (13.5 vs. 20.6 months; p = 0.035), as did poor-risk patients (8.1 vs. 13.9 months; p = 0.049). Conclusions: Antibiotic exposure during the peri-immunotherapy period is linked to significantly poorer outcomes in RCC patients, especially those with intermediate and poor IMDC risk scores. These findings emphasize the importance of antimicrobial stewardship and suggest a potential role for microbiome-informed patient management in RCC.