摘要
目的系统评价类固醇的使用对接受免疫检查点抑制剂(ICIs)治疗非小细胞肺癌(NSCLC)患者无进展生存期(PFS)和总生存期(OS)的影响。方法计算机检索PubMed、EMbase、Cochrane Library、Web of Science以及中国知网、维普、万方等数据库,收集接受ICIs治疗的NSCLC患者使用与未使用类固醇对PFS和OS影响的前瞻性或回顾性研究,检索时间为自建库至2021年4月。由两名研究者独立评价纳入研究的质量、提取资料并交叉核对,采用RevMan 5.3软件进行meta分析;采用Stata 15.0软件进行发表偏倚分析。结果共纳入16项回顾性队列研究,共6682例患者。Meta分析结果显示:与未使用类固醇的患者相比,类固醇的使用降低了患者的PFS[HR=1.50,95%CI(1.25,1.80),P<0.0001]和OS[HR=1.56,95%CI(1.31,1.86),P<0.00001]。亚组分析结果显示:ICIs治疗开始后使用类固醇降低了患者的PFS[HR=1.99,95%CI(1.52,2.60),P<0.00001]和OS[HR=2.33,95%CI(1.61,3.36),P<0.00001];ICIs治疗开始前使用类固醇与患者的PFS和OS无相关性(P>0.05)。因癌症相关症状接受类固醇治疗降低了患者的PFS[HR=1.57,95%CI(1.32,1.88),P<0.00001]和OS[HR=1.65,95%CI(1.21,2.24),P=0.001]。结论在接受ICIs治疗的NSCLC患者中,类固醇的使用与患者较差的预后相关,特别是在ICIs治疗开始后使用或者因癌症相关症状使用,而在ICIs治疗开始前使用类固醇可能不会影响患者的预后。
Objective To systematically evaluate the effect of steroids use on progression-free survival(PFS)and overall survival(OS)of patients treated with immune checkpoint inhibitors(ICIs)for non-small cell lung cancer(NSCLC).Methods Computerized retrieval of PubMed,EMbase,Cochrane Library,Web of Science,CNKI,VIP,Wanfang and other databases was conducted to collect prospective or retrospective studies on the effect of steroids use and non-use on PFS and OS in NSCLC patients treated with ICIs.The retrieval covered from the self-built database to April 2021.Two researchers independently evaluated the quality of the included studies,collected data and cross-checked them.Meta-analysis was performed with RevMan 5.3 software.Stata 15.0 software was used to analyze publication bias.Results Totally 16 retrospective cohort studies involving 6682 patients were included.Meta-analysis showed that the use of steroids reduced PFS[HR=1.50,95%CI(1.25,1.80),P<0.0001]and OS[HR=1.56,95%CI(1.31,1.86),P<0.00001]in patients compared with those who did not use steroids.Subgroup analysis showed that steroids use after the onset of ICIs reduced PFS[HR=1.99,95%CI(1.52,2.60),P<0.00001]and OS[HR=2.33,95%CI(1.61,3.36),P<0.00001].Steroids use before ICIs had no significant correlation with PFS and OS.(P>0.05).Steroids use for cancer-related symptoms reduced PFS[HR=1.57,95%CI(1.32,1.88),P<0.00001]and OS[HR=1.65,95%CI(1.21,2.24),P=0.001].Conclusion Steroids use is associated with poorer prognosis in NSCLC patients treated with ICIs,especially after the onset of ICIs or due to cancer-related symptoms,whereas steroids use before the onset of ICIs is not likely to affect patient outcomes.
作者
王瑞航
华鹏
刘晓波
廖思
江晓春
WANG Rui-hang;HUA Peng;LIU Xiao-bo;LIAO Si;JIANG Xiao-chun(College of Pharmacy,Dali University,Dali Yunnan 671000;Department of Pharmacy,Yunnan Third People’s Hospital,Kunming 650000;Department of Blood Transfusion,Yunnan Third People’s Hospital,Kunming 650000)
出处
《中南药学》
CAS
2022年第3期678-685,共8页
Central South Pharmacy
基金
云南省科学技术厅--云南中医学院应用基础研究联合专项项目[No.2018FF001(-062)]。