糖皮质激素对晚期肿瘤患者免疫疗效影响的Meta分析

目的 探讨糖皮质激素(glucocorticoid, GC)的使用对接受免疫检查点抑制剂(immune checkpoint inhibitors, ICIs)治疗的肿瘤患者的总生存期(overall survival, OS)和无进展生存期(progression-free survival, PFS)的影响。方法 使用PubMed、Wiley、Web of Science和Cochrane Library数据库检索2020年10月以前发表的有关肿瘤患者在接受ICIs治疗期间,GC使用对患者预后影响的文献,采用Review Manager 5.3软件和Stata14.0软件进行统计分析。结果 总共有23篇文献被纳入荟萃分析,Meta分析结果显示在晚期肿瘤患者接受ICIs治疗期间,GC的使用是死亡(H R=1.54, 95% C I=1.29~1.83)和疾病进展(H R=1.82, 95% C I=1.36~2.43)的危险因素。此外,亚组分析结果显示,GC用于缓解脑水肿、癌痛等肿瘤相关并发症时会增加患者死亡(H R=2.14, 95% C I=1.62~2.81)和疾病进展(H R=2.26,95% C I=1.72~2.96)的风险。然而,GC被用于处理免疫相关不良反应(immune-related adverse events,irAEs)等非肿瘤相关性并发症,GC的使用与未使用或者小剂量(<10 mg/d)使用相比差异无统计学意义(P>0.05)。结论 当GC用于处理肿瘤相关性并发症时,GC的使用对接受免疫治疗的肿瘤患者的预后会造成负面影响。

Meta analysis on effects of glucocorticoid on the immunotherapy of advanced cancer

Objective To evaluate the application of glucocorticoid on the overall survival (OS) and progression-free survival (PFS) of the cancer patients receiving immune checkpoint inhibitors (ICIs). Methods PubMed, Wiley, Web of Science and Cochrane Library databases were applied to search the papers for effects of GC on cancer patients during the therapy period of receiving ICIs published prior to October 2020. Review Manager 5.3 software and Stata 14.0 software were used for statistical analysis. Results A total of 23 studies were included in the meta analysis, Meta-analysis showed that for patients with advanced cancer during the period of ICIs, the application of GC was a risk factor for death (H R=1.54, 95% C I=1.29-1.83) and disease progression (H R=1.82, 95% C I=1.36-2.43). Moreover, the subgroup analysis showed that GC applied to relief tumor-related complications including the cerebraledema and cancer pain increased the risk of death (H R=2.14, 95% C I=1.62-2.81) and disease progression (H R=2.26, 95% C I=1.72-2.96). While GC was used to treat non-tumor-related complications including immune-related adverse events (irAEs), and the difference between the use of GC and no-use or low dose of GC (<10 mg/d) wasn’t statistically significant (P>0.05). Conclusion The application of GC has negative effects on the prognosis of cancer patients receiving immunotherapy when it is used to treat tumor-related complications.