Objective: Glioblastomas are the most common primary central nervous system (CNS) tumors. Although modern management strategies have modestly improved overall survival, the prognosis remains dismal, with treatment side effects often impinging on the clinical course. Glioblastomas cause neurological dysfunction by infiltrating CNS tissue and via perifocal oedema formation. The administration of steroids such as dexamethasone is thought to alleviate symptoms by reducing oedema. However, despite its widespread use, the evidence for the administration of dexamethasone is limited and conflicting. Therefore, we aimed to review the current evidence concerning the use and outcomes of dexamethasone in patients with glioblastoma. Methods: We performed a systematic review and meta-analysis according to the PRISMA-P guidelines. We performed a restricted search using the keywords “Dexamethasone” and “Glioblastoma” on PubMed, Web of Science, Cochrane Library, and Academic Search Premier. We included studies reporting on overall survival (OS) and progression-free survival (PFS) in glioblastoma patients receiving higher or lower dexamethasone doses. The risk of bias was assessed using ROBINS-I. We performed a meta-analysis using a random effects model for OS and PFS. Results: Twenty-two retrospective studies were included. Higher doses of dexamethasone were associated with poorer OS (hazard ratio 1.62, confidence interval 1.40–1.88) and PFS (1.49, 1.23–1.81). OS remained worse even when studies corrected for clinical status (1.52, 1.38–1.67). Conclusion: Despite the widespread use of dexamethasone in glioblastoma patients, its use is correlated with worse long-term outcomes. Consequently, Dexamethasone administration should be restricted to selected symptomatic patients. Future prospective studies are crucial to confirm these findings.
目的：胶质母细胞瘤是最常见的原发性中枢神经系统肿瘤。尽管现代治疗策略在一定程度上改善了患者的总生存期，但其预后仍然不佳，且治疗副作用常影响临床病程。胶质母细胞瘤通过浸润中枢神经系统组织及形成瘤周水肿导致神经功能障碍。地塞米松等类固醇药物的使用被认为可通过减轻水肿缓解症状。然而，尽管地塞米松被广泛使用，其应用证据仍有限且存在争议。因此，本研究旨在系统回顾地塞米松在胶质母细胞瘤患者中应用及其临床结局的现有证据。 方法：根据PRISMA-P指南进行系统综述与荟萃分析。在PubMed、Web of Science、Cochrane Library和Academic Search Premier数据库中，以“地塞米松”和“胶质母细胞瘤”为关键词进行限定检索。纳入报告接受高剂量或低剂量地塞米松治疗的胶质母细胞瘤患者总生存期和无进展生存期的研究。采用ROBINS-I工具评估偏倚风险，并运用随机效应模型对总生存期和无进展生存期进行荟萃分析。 结果：共纳入22项回顾性研究。高剂量地塞米松与较差的总生存期（风险比1.62，置信区间1.40-1.88）和无进展生存期（1.49，1.23-1.81）相关。即使在校正临床状态的研究中，总生存期仍呈现恶化趋势（1.52，1.38-1.67）。 结论：尽管地塞米松在胶质母细胞瘤患者中应用广泛，但其使用与较差的长期预后相关。因此，地塞米松应仅限于特定有症状的患者使用。未来前瞻性研究对验证这些发现至关重要。
Dexamethasone in Patients with Glioblastoma: A Systematic Review and Meta-Analysis
肿瘤(癌症)患者之家