激素使用降低胶质母细胞瘤生存期，因此在胶质母细胞瘤治疗过程中应当在最短的时间内使用最低剂量的糖皮质激素。
研究背景
类固醇通常用于治疗手术和基于替莫唑胺的放化疗的多形性胶质母细胞瘤（GBM）患者治疗过程中的脑水肿。
糖皮质激素的不良反应包括淋巴细胞减少症，高血糖症和感染风险。
意大利的Petrelli等报告了荟萃分析的结果，评估了与GBM治疗相关的类固醇对预后的影响。
研究方法
对PubMed，Cochrane图书馆和Embase进行了搜索，截至到2019年9月，成年GBM且接受或未接受类固醇治疗后患者预后的观察性或前瞻性研究。
总生存期（OS）是主要终点，无进展生存期（PFS）是次要终点。效应大小为危险比（HR），置信区间（CI）为95％，与非使用类固醇激素者相比，HR> 1与最差结果相关。
研究结果
选择出22篇文献，8752名病人。主要分析中（n = 22研究报告数据），在治疗期间服用类固醇的GBM患者OS降低（HR = 1.54，95％CI 1.37-1.75；p <0.01）。
同样，在现有数据中（n = 9），类固醇激素使用者的PFS较差（HR = 1.28，95％CI 1.1-1.49；p <0.01）。
结论
对于患有GBM并接受RT和/或CT治疗的患者，与类固醇联合使用会显着降低生存率和PFS。为了达到治疗目标和预防类固醇相关并发症，在最短的时间内使用最低剂量的糖皮质激素是治疗该疾病的基本目标。
下面是使用激素对OS和PFS影响的森林图：
下面是文章的摘要：
Abstract
INTRODUCTION:
Steroids are commonly used for managing brain edema in patients with glioblastoma multiforme (GBM), treated with surgery and concomitant temozolomide-based chemoradiotherapy (CTRT). The adverse effects of glucocorticoids include lymphopenia, hyperglycemia, and risk of infection. We report the results of a meta-analysis evaluating the effects of steroids on outcome when associated with the treatment of GBM.
METHODS:
PubMed, the Cochrane Library, and Embase were searched from inception until September 2019 for observational or prospective studies reporting prognosis of adult patients with GBM and treated or not treated with steroids. Overall survival (OS) was the primary endpoint, and progression-free survival (PFS) was the secondary endpoint. The effect size was reported as hazard ratios (HRs) with a 95% confidence interval (CI), and an HR > 1 associated with the worst outcome in steroid users compared to non-users.
RESULTS:
Twenty-two publications were retrieved from studies selected for a total of 8,752 patients. In the primary analysis (n = 22 studies reporting data), OS was reduced in GBM patients taking steroids during treatment (HR = 1.54, 95% CI 1.37-1.75; p < 0.01). Similarly, PFS was inferior in steroid users in n = 9 studies with data available (HR = 1.28, 95% CI 1.1-1.49; p < 0.01).
CONCLUSIONS:
In patients with GBM and treated with RT and/or CT, association with steroids significantly reduces survival and PFS. Use of the lowest dose of glucocorticoids for the shortest period needed to achieve the treatment goals and spanvention of steroid-associated complications are essential aims of treatment of this disease.
参考文献：
1. Petrelli F, De Stefani A, Ghidini A, et al. Steroids use and survival in patients with glioblastoma multiforme: a pooled analysis. J Neurol. January 2020. doi:10.1007/s00415-020-09731-5
