Influence of Klebsiella pneumoniae and quinolone treatment on prognosis in patients with pancreatic cancer. Issue 6 (30th September 2020)

• Record Type: Journal Article
• Authors: Weniger, M; Hank, T; Qadan, M; Ciprani, D; Michelakos, T; Niess, H; Heiliger, C; Ilmer, M; D'Haese, J G; Ferrone, C R; Warshaw, A L; Lillemoe, K D; Werner, J; Liss, A; Fernández‐del Castillo, C
• Is Part Of: British journal of surgery. Volume 108:Issue 6(2021)
• Page Start: 709
• Page End: 716
• Publication Date: 2020-09-30
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1002/bjs.12003
• Languages: English
• ISSNs: 0007-1323

Abstract

Abstract : The microbiome may affect the biology of pancreatic cancer. In this study, Klebsiella pneumoniae detected in intraoperative bile cultures predicted progression‐free survival and potentially chemoresistance towards gemcitabine in pancreatic ductal adenocarcinoma. Treatment with quinolones was associated with prolonged survival in patients colonized with K. pneumoniae and could help counter its deleterious effects. KP, Klebsiella pneumoniae. Bad bacteria Abstract: Background: An increasing body of evidence suggests that microbiota may promote progression of pancreatic ductal adenocarcinoma (PDAC). It was hypothesized that gammaproteobacteria (such as Klebsiella 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) (–1·9 (95 per cent c.i. –3·3 to –0·5) months per species; P = 0·009). Adjuvant treatment with gemcitabine improved PFS in patients who were negative for K. pneumoniae (26·2 versus 15·3 months; P = 0·039), but not in those who tested positive (19·5 versus 13·2 months; P = 0·137). Quinolone treatment was associated with improved median overall survival (OS) independent of K. pneumoniae status (48·8 versus 26·2 months; P = 0·006) and among those who tested positive for K. pneumoniae (median not reached versus 18·8 months; P = 0·028). Patients with quinolone‐resistant K. pneumoniae had shorter PFS than those with quinolone‐sensitive K. pneumoniae (9·1 versus 18·8 months; P = 0·001). Conclusion: K. pneumoniae may promote chemoresistance to adjuvant gemcitabine, and quinolone treatment is associated with improved survival.