Systematic Review and Meta-Analysis on the Role of Perioperative Blood Transfusion in Patients Undergoing Radical Cystectomy for Urothelial Carcinoma.

IF 1 4区医学 Q4 ONCOLOGY Bladder Cancer Pub Date : 2022-09-15 eCollection Date: 2022-01-01 DOI:10.3233/BLC-201534

Maxim Kochergin, Omar Fahmy, Lisa Esken, Thorsten Goetze, Evanguelos Xylinas, Christian G Stief, Georgios Gakis

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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.

Objectives: 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).

Conclusion: 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.

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围手术期输血在尿路上皮癌根治性膀胱切除术中作用的系统评价和Meta分析

背景：根治性膀胱切除术（RC）是癌症患者的治疗标准。围手术期红细胞（RBC）输注对RC后肿瘤学结果的影响尚不明确，因为现有出版物显示了相互矛盾的结果。目的：本系统综述和荟萃分析的目的是研究围手术期红细胞输注对RC后肿瘤学结果的预后作用。方法：根据PRISMA标准，在PubMed上对报告RC期间红细胞输注的出版物进行系统的在线搜索。包括以下标准的出版物：（I）围手术期输血的报告数据；（II）报告的输血对生存结果影响的危险比（HR）和95%置信区间（CI）。主要结果是围手术期红细胞输注对无复发生存率（RFS）、癌症特异性生存率（CSS）和总生存率（OS）的影响。使用Newcastle Ottawa量表进行偏倚风险评估。使用Revman 5.4软件进行统计分析。结果：从27篇初步确定的出版物中，选择了19篇符合条件的文章，包括22897名患者。围手术期红细胞输注对RFS无影响（Z = 1.34；p = 0,18）和对CSS的显著负面影响（Z = 2.67；p = 0.008）和OS（Z = 3.22；p = 0.001）。术中红细胞输注对RFS无影响（Z = 0.58；p = 0.56）和CSS（Z = 1.06；p = 0.29）和OS（Z = 1.47；p = 0.14）。术后红细胞输注显示RFS无明显改善趋势（Z = 1.89；p = 0.06），并且对CSS没有影响（Z = 1.56；p = 0.12）和OS（Z = 0.53便士 = 0.60）。结论：在这项荟萃分析中，我们发现围手术期输血仅是CSS和OS恶化的重要预测因素，而不是RFS。这种影响可能由肿瘤分期和患者合并症的差异决定，由于缺乏相应的原始数据，该荟萃分析无法控制这些差异。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Bladder Cancer Medicine-Urology

CiteScore

1.60

自引率

0.00%

发文量

期刊介绍： Bladder Cancer is an international multidisciplinary journal to facilitate progress in understanding the epidemiology/etiology, genetics, molecular correlates, pathogenesis, pharmacology, ethics, patient advocacy and survivorship, diagnosis and treatment of tumors of the bladder and upper urinary tract. The journal publishes research reports, reviews, short communications, and letters-to-the-editor. The journal is dedicated to providing an open forum for original research in basic science, translational research and clinical medicine that expedites our fundamental understanding and improves treatment of tumors of the bladder and upper urinary tract.