肺癌是全球第二大常见癌症，其中非小细胞肺癌（NSCLC）占大多数病例。非小细胞肺癌患者通过针对免疫检查点的免疫疗法获得了巨大的生存获益。糖皮质激素 (GC) 经常用于缓解癌症相关症状、非癌症相关症状的支持治疗以及免疫相关不良事件 (irAE) 的管理。本研究的目的是阐明糖皮质激素在接受免疫检查点抑制剂（ICIs）治疗的晚期 NSCLC 患者中使用的安全性和预后意义。该研究检索了 PubMed、Embase、Cochrane Library、Web of Science、China Biology Medicine Disc 等出版物、中国国家知识基础设施、万方数据和中国科技期刊数据库截至2022年3月1日，并进行荟萃分析以评估糖皮质激素使用对总生存期（OS）和无进展生存期（PFS）的影响根据现有数据，在接受 ICI 治疗的 NSCLC 患者中。该研究计算了汇总风险比（HR）和95％置信区间（CI）。该研究纳入了25篇文献的数据，主要是回顾性的，共纳入8713名患者。与不服用 GC 的患者相比，服用 GC 的患者肿瘤进展和死亡的风险更高（PFS：HR = 1.57，95% CI：1.33-1.86，P <0.001；OS：HR = 1.63，95% CI：1.41-1.88 ，P <0.001）。用于治疗癌症相关症状的 GC 对 PFS 和 OS 均造成明显的负面影响（PFS：HR = 1.74，95% CI：1.32-2.29，P <0.001；OS：HR = 1.76，95% CI：1.52-2.04， P <0.001）。然而，用于 irAE 管理的 GC 并未对预后产生负面影响（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），用于非癌症相关适应症的 GC 对预后没有影响（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)。在接受 ICI 治疗的晚期 NSCLC 患者中，使用 GC 来缓解癌症相关症状可能会导致 PFS 和 OS 更差，表明它们会增加肿瘤进展和死亡的风险。但是，在接受 ICI 治疗的 NSCLC 患者中，使用 GC 来治疗 irAE 可能是安全的，并且使用 GC 来治疗非癌症相关症状可能不会影响 ICI 的生存获益。因此，在个体化临床管理中，GCs给药前必须谨慎、合理评估适应症。版权所有©2023中华医学会，由Wolters Kluwer, Inc.制作，CC-BY-NC-ND许可。

Lung cancer is the second most common cancer worldwide, with non-small-cell lung cancer (NSCLC) accounting for the majority of cases. Patients with NSCLC have achieved great survival benefits from immunotherapies targeting immune checkpoints. Glucocorticoids (GCs) are frequently used for palliation of cancer-associated symptoms, as supportive care for non-cancer-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).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 progression-free survival (PFS) in NSCLC patients treated with ICIs through the available data. The study calculated the pooled hazard ratios (HRs) and 95% confidence intervals (CIs).This study included data from 25 literatures that were mainly retrospective, with 8713 patients included. 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, P <0.001; OS: HR = 1.63, 95% CI: 1.41-1.88, P <0.001). 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, P <0.001; OS: HR = 1.76, 95% CI: 1.52-2.04, P <0.001). 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).In advanced NSCLC patients treated with ICIs, the use of GCs for palliation of cancer-associated symptoms may result in a worse PFS and OS, indicating that they increase the risk of tumor progression and death. But, in NSCLC patients treated with ICIs, the use of GCs for the management of irAEs may be safe, and the use of GCs for the treatment of non-cancer-associated symptoms may not affect the ICIs' survival benefits. Therefore, it is necessary to be careful and evaluate indications rationally before administering GCs in individualized clinical management.Copyright © 2023 The Chinese Medical Association, produced by Wolters Kluwer, Inc. under the CC-BY-NC-ND license.