摘要
目的分析接受根治性膀胱切除患者围手术期输血与无复发生存率、肿瘤特异性生存率和总生存率之间的相关性。方法计算机检索Pub Med、EMbase、Cochrane Library、Clinical Trials.gov、CBM、CNKI和Wan Fang Data数据库,查找围手术期输血与膀胱癌手后临床结局相关性的随机对照试验、队列研究和病例对照研究,检索时限均为从建库-2015年12月。采用Cochrane偏倚风险工具和Ottawa-Newcastle量表分别评价纳入随机对照试验和队列研究/病例对照研究的方法学质量。结果共纳入8篇研究,结果显示围手术期输血增加总体死亡风险的相关性为27%(HR 1.27[1.15-1.40]),I2为68%。围手术期输血后的肿瘤特异性生存率比不输血组低29%(HR 1.29[1.13-1.46]),I2为61%。围手术期输血无复发生存率比不输血的要低21%(HR 1.21[1.12-1.31]),I2为0%。本文的局限性主要是纳入了队列研究和病例对照研究,其潜在的偏倚可能会夸大结果。结论围手术期输血与降低无复发生存率,肿瘤特异性生存率和总生存率存在显著相关性。但仍需要设计一些设计良好的前瞻性随机对照试验提供高质量的证据进一步论证该问题。
Objective To investigate the impact of perioperative blood transfusions on oncological outcomes after radical cystectomy. Methods Pubmed, EMBASE, the Cochrane library and ClinicalTrials.gov, CBM, CNKI and WanFang Data were extensively searched to identify relevant literature for studies that focused on the relationship of perioperative bloodtransfusions and outcomes of patients undergoing bladder cancer surgery from inception to December 2015. A fixed or random effects model was used in this meta-analysis to calculate the pooled hazard ratio （HR） with 95% confidence intervals （CIs）. Cochrane risk of bias tools and Ottawa-Newcastle scales were used to evaluate the methodologist quality of included studies. Results A total of 15 655 patients in 8 studies matched the selection criteria, among which eight, seven, and five studies were included in the overall Survival （ OS）, cancer-specif- ic survival （CSS）, and recurrence free survival （RFS） analysis, respectively. Blood transfusions were associated with 27 % reduction （HR 1.27 [ 1.15-1.40] ） （I^2 =68%） in OS; 29% reduction （ HR 1.29 [ 1.13-1.46] ） （I^2 =61%） in CSS; and 12% reduction （HR 1.21 [ 1.12-1.31 ] ） （I^2= 0%） in RFS. This study had several limitations; however the main prob- lem is that it included only retrospective studies. Conclusions Perioperative BT may be associated with reduced RFS, CSS, and OS in patients undergoing RC for BC. A randomized controlled study is needed to determine the causality between the ad- ministration of blood transfusions and bladder cancer recurrence.
出处
《中国输血杂志》
CAS
北大核心
2016年第12期1363-1367,共5页
Chinese Journal of Blood Transfusion
关键词
围手术期输血
膀胱癌手术
系统评价
META分析
perioperative blood transfusions
bladder cancer surgery
systematic review
meta-analysis
