PDF(Pubmed)
Abstract：
BACKGROUND: Radical cystectomy (RC) is the standard of care in patients with muscle-invasive bladder cancer. The impact of perioperative red blood cell (RBC) transfusion on oncological outcomes after RC is not clearly established as the existing publications show conflicting results.
OBJECTIVE: The aim of this systematic review and meta-analysis was to investigate the prognostic role of perioperative RBC transfusion on oncological outcomes after RC.
METHODS: Systematic online search on PubMed was conducted, based on PRISMA criteria for publications reporting on RBC transfusion during RC. Publications with the following criteria were included: (I) reported data on perioperative blood transfusion; (II) Reported Hazard ratio (HR) and 95% -confidence interval (CI) for the impact of transfusion on survival outcomes. Primary outcome was the impact of perioperative RBC transfusion on recurrence-free survival (RFS), cancer-specific survival (CSS) and overall survival (OS). Risk of bias assessment was performed using Newcastle-Ottawa Scale. Statistical analysis was performed using Revman 5.4 software.
RESULTS: From 27 primarily identified publications, 19 eligible articles including 22897 patients were selected. Perioperative RBC transfusion showed no impact on RFS (Z = 1.34; p = 0,18) and significant negative impact on CSS (Z = 2.67; p = 0.008) and OS (Z = 3.22; p = 0.001). Intraoperative RBC transfusion showed no impact on RFS (Z = 0.58; p = 0.56) and CSS (Z = 1.06; p = 0.29) and OS (Z = 1.47; p = 0.14).Postoperative RBC transfusion showed non-significant trend towards improved RFS (Z = 1.89; p = 0.06) and no impact on CSS (Z = 1.56; p = 0.12) and OS (Z = 0.53 p = 0.60).
CONCLUSIONS: In this meta-analysis, we found perioperative blood transfusion to be a significant predictor only for worse CSS and OS but not for RFS. This effect may be determined by differences in tumor stages and patient comorbidities for which this meta-analysis cannot control due to lack of respective raw data.
OBJECTIVE: The aim of this systematic review and meta-analysis was to investigate the prognostic role of perioperative RBC transfusion on oncological outcomes after RC.
METHODS: Systematic online search on PubMed was conducted, based on PRISMA criteria for publications reporting on RBC transfusion during RC. Publications with the following criteria were included: (I) reported data on perioperative blood transfusion; (II) Reported Hazard ratio (HR) and 95% -confidence interval (CI) for the impact of transfusion on survival outcomes. Primary outcome was the impact of perioperative RBC transfusion on recurrence-free survival (RFS), cancer-specific survival (CSS) and overall survival (OS). Risk of bias assessment was performed using Newcastle-Ottawa Scale. Statistical analysis was performed using Revman 5.4 software.
RESULTS: From 27 primarily identified publications, 19 eligible articles including 22897 patients were selected. Perioperative RBC transfusion showed no impact on RFS (Z = 1.34; p = 0,18) and significant negative impact on CSS (Z = 2.67; p = 0.008) and OS (Z = 3.22; p = 0.001). Intraoperative RBC transfusion showed no impact on RFS (Z = 0.58; p = 0.56) and CSS (Z = 1.06; p = 0.29) and OS (Z = 1.47; p = 0.14).Postoperative RBC transfusion showed non-significant trend towards improved RFS (Z = 1.89; p = 0.06) and no impact on CSS (Z = 1.56; p = 0.12) and OS (Z = 0.53 p = 0.60).
CONCLUSIONS: In this meta-analysis, we found perioperative blood transfusion to be a significant predictor only for worse CSS and OS but not for RFS. This effect may be determined by differences in tumor stages and patient comorbidities for which this meta-analysis cannot control due to lack of respective raw data.
摘要：
背景：根治性膀胱切除术（RC）是肌层浸润性膀胱癌患者的标准治疗方法。围手术期红细胞（RBC）输血对RC后肿瘤学结果的影响尚未明确，因为现有出版物显示出相互矛盾的结果。
目的：本系统综述和荟萃分析的目的是探讨围手术期红细胞输注对RC术后肿瘤预后的影响。
方法：在PubMed上进行了系统的在线搜索，根据PRISMA标准报告RC期间红细胞输血的出版物。包括以下标准的出版物：（I）报告了围手术期输血的数据；（II）报告了输血对生存结果影响的危险比（HR）和95％置信区间（CI）。主要结局是围手术期红细胞输注对无复发生存率（RFS）的影响，癌症特异性生存率（CSS）和总生存率（OS）。使用纽卡斯尔-渥太华量表进行偏倚风险评估。采用Revman5.4软件进行统计分析。
结果：从27个主要确定的出版物中，入选合格文献19篇，包括22897例患者。围手术期红细胞输注对RFS无影响(Z=1.34;p=0,18),对CSS(Z=2.67;p=0.008)和OS(Z=3.22;p=0.001)有显著的负面影响。术中红细胞输注对RFS(Z=0.58;p=0.56)、CSS(Z=1.06;p=0.29)和OS(Z=1.47;p=0.14)无影响。术后红细胞输注对改善RFS(Z=1.89；p=0.06)无显著趋势，对CSS(Z=1.56；p=0.12)和OS(Z=0.53p=0.60)无影响。
结论：在本荟萃分析中，我们发现围手术期输血仅是CSS和OS恶化的重要预测因子,而不是RFS。这种效果可以通过肿瘤分期和患者合并症的差异来确定，由于缺乏相应的原始数据，这种荟萃分析无法控制。
目的：本系统综述和荟萃分析的目的是探讨围手术期红细胞输注对RC术后肿瘤预后的影响。
方法：在PubMed上进行了系统的在线搜索，根据PRISMA标准报告RC期间红细胞输血的出版物。包括以下标准的出版物：（I）报告了围手术期输血的数据；（II）报告了输血对生存结果影响的危险比（HR）和95％置信区间（CI）。主要结局是围手术期红细胞输注对无复发生存率（RFS）的影响，癌症特异性生存率（CSS）和总生存率（OS）。使用纽卡斯尔-渥太华量表进行偏倚风险评估。采用Revman5.4软件进行统计分析。
结果：从27个主要确定的出版物中，入选合格文献19篇，包括22897例患者。围手术期红细胞输注对RFS无影响(Z=1.34;p=0,18),对CSS(Z=2.67;p=0.008)和OS(Z=3.22;p=0.001)有显著的负面影响。术中红细胞输注对RFS(Z=0.58;p=0.56)、CSS(Z=1.06;p=0.29)和OS(Z=1.47;p=0.14)无影响。术后红细胞输注对改善RFS(Z=1.89；p=0.06)无显著趋势，对CSS(Z=1.56；p=0.12)和OS(Z=0.53p=0.60)无影响。
结论：在本荟萃分析中，我们发现围手术期输血仅是CSS和OS恶化的重要预测因子,而不是RFS。这种效果可以通过肿瘤分期和患者合并症的差异来确定，由于缺乏相应的原始数据，这种荟萃分析无法控制。
