Effects of glucocorticoid use on survival of advanced non-small-cell lung cancer patients treated with immune checkpoint inhibitors

作     者：Nijiao Li Xuliang Zheng Jinyan Gan Ting Zhuo Xiaohong Li Chuyi Yang Yanbin Wu Shouming Qin 

作者机构：The First Affiliated Hospital of Guangxi Medical UniversityNanningGuangxi 530021China Department of Pulmonary and Critical Care MedicineThe First Affiliated Hospital of Guangxi Medical UniversityNanningGuangxi 530021China 

出 版 物：《Chinese Medical Journal》 (中华医学杂志（英文版）)

年 卷 期：2023年第136卷第21期

页      面：2562-2572页

核心收录：

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

基　　金：supported by grants from the Guangxi Medical and Health Appropriate Technology Development and Promotion Application Project(No.S201659) the Self-financing Research Projects of Guangxi Zhuang Autonomous Region Health and Family Planning Commission(No.Z20180970) 

主　　题：Glucocorticoids Immune checkpoint inhibitor Meta-analysis Non-small-cell lung cancer Prognosis 

摘      要：Background:Lung cancer is the second most common cancer worldwide,with non-small-cell lung cancer(NSCLC)accounting for the majority of *** with NSCLC have achieved great survival benefits from immunotherapies targeting immune ***(GCs)are frequently used for palliation of cancer-associated symptoms,as supportive care for noncancer-associated symptoms,and for management of immune-related adverse events(irAEs).The aim of this study was to clarify the safety and prognostic significance of glucocorticoid use in advanced patients with NSCLC treated with immune checkpoint inhibitors(ICIs).Methods:The study searched publications from PubMed,Embase,Cochrane Library,Web of Science,China Biology Medicine disc,Chinese National Knowledge Infrastructure,Wanfang Data,and Chinese Science and Technology Journal Database up to March 1st,2022,and conducted a meta-analysis to assess the effects of glucocorticoid use on overall survival(OS)and progressionfree survival(PFS)in NSCLC patients treated with ICIs through the available *** study calculated the pooled hazard ratios(HRs)and 95%confidence intervals(CIs).Results:This study included data from 25 literatures that were mainly retrospective,with 8713 patients *** taking GCs had a higher risk for tumor progression and death compared with those not taking GCs(PFS:HR=1.57,95%CI:1.33-1.86,P0.001;OS:HR=1.63,95%CI:1.41-1.88,P0.001).GCs used for cancer-associated symptoms caused an obviously negative effect on both PFS and OS(PFS:HR=1.74,95%CI:1.32-2.29,P0.001;OS:HR=1.76,95%CI:1.52-2.04,P0.001).However,GCs used for irAEs management did not negatively affect prognosis(PFS:HR=0.68,95%CI:0.46-1.00,P=0.050;OS:HR=0.53,95%CI:0.34-0.83,P=0.005),and GCs used for non-cancer-associated indications had no effect on prognosis(PFS:HR=0.92,95%CI:0.63-1.32,P=0.640;OS:HR=0.91,95%CI:0.59-1.41,P=0.680).Conclusions:In advanced NSCLC patients treated with ICIs,the use of GCs for palliation of cancer-asso