Saint Louis University School of Medicine, Saint Louis, MO, 63104, USA.
Department of Radiation Oncology, Washington University School of Medicine, 4921 Parkview Place, Campus Box 8224, St. Louis, MO, 63110, USA.
J Neurooncol. 2019 May;143(1):129-136. doi: 10.1007/s11060-019-03146-7. Epub 2019 Mar 12.
Corticosteroids are commonly used to alleviate symptoms from cerebral vasogenic edema in glioblastoma (GBM) patients. This study evaluated the impact of overall corticosteroid exposure during chemoradiotherapy (CRT) on acute severe lymphopenia (ASL) and survival outcomes of GBM patients.
GBM patients treated with CRT from 2007 to 2016 were retrospectively analyzed. Overall corticosteroid exposure was estimated as the average daily dexamethasone dose during 6 weeks of CRT. ASL was defined as grade 3 or higher lymphopenia within 3 months of starting CRT. ASL rates, overall survival (OS), and progression-free survival (PFS) were analyzed using Kaplan-Meier method. Multivariable analysis (MVA) was performed using logistic and Cox regression to identify independent predictors of ASL and survival outcomes, respectively.
Of the 319 eligible patients, the median daily dexamethasone use was 2 mg/day. The high-dose dexamethasone cohort (> 2 mg/day) had significantly higher ASL and worse OS than the low-dose dexamethasone cohort: 3-month ASL of 43.7% versus 19.8% (p < 0.003) and median OS of 12.6 months versus 17.9 months (p < 0.001), respectively. On MVA, higher dexamethasone use was independently associated with higher ASL and worse OS, but not worse PFS. A subset analysis of patients with gross-total resection found that higher dexamethasone use was significantly associated with ASL, but not OS.
Increased corticosteroid use among GBM patients during CRT appears to be an independent risk factor for developing subsequent ASL. Its apparent association with worse OS may be influenced by other confounding factors and would need to be validated through prospective investigations.
皮质类固醇常用于缓解胶质母细胞瘤（GBM）患者的血管源性脑水肿引起的症状。本研究评估了在放化疗（CRT）期间全身皮质类固醇暴露对 GBM 患者急性严重淋巴细胞减少症（ASL）和生存结局的影响。
回顾性分析了 2007 年至 2016 年接受 CRT 治疗的 GBM 患者。将 6 周 CRT 期间的平均日地塞米松剂量估计为全身皮质类固醇暴露。ASL 定义为 CRT 开始后 3 个月内出现 3 级或更高级别的淋巴细胞减少症。使用 Kaplan-Meier 法分析 ASL 发生率、总生存期（OS）和无进展生存期（PFS）。使用逻辑回归和 Cox 回归进行多变量分析（MVA），以分别确定 ASL 和生存结局的独立预测因素。
在 319 名符合条件的患者中，中位地塞米松日用量为 2mg/天。高剂量地塞米松组（>2mg/天）的 3 个月 ASL 发生率（43.7%对 19.8%，p<0.003）和中位 OS（12.6 个月对 17.9 个月，p<0.001）均显著高于低剂量地塞米松组。MVA 显示，更高的地塞米松使用与更高的 ASL 和更差的 OS 相关，但与更差的 PFS 无关。在全切除患者的亚组分析中，发现更高的地塞米松使用与 ASL 显著相关，但与 OS 无关。
在 CRT 期间，GBM 患者皮质类固醇使用量的增加似乎是发生后续 ASL 的独立危险因素。它与较差 OS 的明显关联可能受到其他混杂因素的影响，需要通过前瞻性研究加以验证。
