Immune checkpoint inhibitors (ICIs) are widely used in lung cancer treatment, but outcomes among patients with comorbid type 2 diabetes mellitus (T2DM) remain uncertain. A systematic review and meta-analysis published in Frontiers in Endocrinology evaluated whether T2DM was associated with poorer survival outcomes in patients receiving ICIs.
The analysis searched PubMed, Embase, Web of Science, CNKI, and Wanfang Database through January 2026 and included 6 studies involving 1,225 participants. Risk of bias was assessed using the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool. The primary outcomes were overall survival (OS) and progression-free survival (PFS).
Findings
- Patients with T2DM receiving ICIs had poorer OS (hazard ratio [HR], 1.49; 95% confidence interval [CI], 1.25–1.77; p<0.00001) and PFS (HR, 1.38; 95% CI, 1.04–1.83; p=0.03).
- Subgroup analyses showed consistently poorer OS regardless of study sample size or survival analysis method.
- Worse PFS was observed primarily in smaller studies (n<200) and in univariate analyses.
- No statistically significant PFS difference was observed in larger studies (n>200) or after multivariate adjustment.
T2DM was associated with poorer OS among patients with lung cancer receiving ICIs. However, the limited number of studies, retrospective study designs, and inconsistent PFS findings warrant cautious interpretation. Current evidence remains insufficient to determine whether glycemic control influences ICI treatment outcomes.
