Influence of Klebsiella pneumoniae and quinolone treatment on prognosis in patients with pancreatic cancer

AbstrasctBackground An increasing body of evidence suggests that microbiota may promote progression of pancreatic ductal adenocarcinoma (PDAC). It was hypothesized that gammaproteobacteria (such asKlebsiella pneumoniae) influence survival in PDAC, and that quinolone treatment may attenuate this effect. Methods This was a retrospective study of patients from the Massachusetts General Hospital (USA) and Ludwig-Maximilians-University (Germany) who underwent preoperative treatment and pancreatoduodenectomy for locally advanced or borderline resectable PDAC between January 2007 and December 2017, and for whom a bile culture was available. Associations between tumour characteristics, survival data, antibiotic use and results of intraoperative bile cultures were investigated. Survival was analysed using Kaplan-Meier curves and Cox regression analysis. Results Analysis of a total of 211 patients revealed that an increasing number of pathogen species found in intraoperative bile cultures was associated with a decrease in progression-free survival (PFS) (-1 center dot 9 (95 per cent c.i. -3 center dot 3 to -0 center dot 5) months per species;P = 0 center dot 009). Adjuvant treatment with gemcitabine improved PFS in patients who were negative forK. pneumoniae(26 center dot 2versus15 center dot 3 months;P = 0 center dot 039), but not in those who tested positive (19 center dot 5versus13 center dot 2 months;P = 0 center dot 137). Quinolone treatment was associated with improved median overall survival (OS) independent ofK. pneumoniaestatus (48 center dot 8versus26 center dot 2 months;P = 0 center dot 006) and among those who tested positive forK. pneumoniae(median not reachedversus18 center dot 8 months;P = 0 center dot 028). Patients with quinolone-resistantK. pneumoniaehad shorter PFS than those with quinolone-sensitiveK. pneumoniae(9 center dot 1versus18 center dot 8 months;P = 0 center dot 001). Conclusion K. pneumoniaemay promote chemoresistance to adjuvant gemcitabine, and quinolone treatment is associated with improved survival.

Automated summary

Microbiota may promote the progression of PDAC, with Klebsiella pneumoniae potentially influencing survival in PDAC. The study found that an increasing number of pathogen species in intraoperative bile cultures was associated with decreased progression-free survival, and that quinolone treatment improved overall survival, especially in patients positive for K. pneumoniae.