Institute of Social and Preventive Medicine, University of Bern, Switzerland.
Acta Haematol. 2011;125(1-2):55-67. doi: 10.1159/000318897. Epub 2010 Dec 8.
Anemia associated with cancer and cancer therapy is a common and important issue in the treatment of patients with malignant disease. Conventionally, blood transfusions are used to treat severe cancer-related anemia. Short- and long-acting preparations of recombinant human erythropoiesis-stimulating agents (ESAs) offer an alternative treatment option. Multiple studies and subsequent meta-analyses have demonstrated that ESA treatment increases hemoglobin levels and reduces the likelihood of transfusion for a proportion of treated patients. However, studies that attempted to evaluate whether ESAs improve tumor response and survival have generated conflicting evidence. Results of smaller trials reporting improved survival outcomes were contradicted by large randomized controlled trials that reported more deaths in patients receiving ESAs. In addition, there is strong evidence that cancer patients receiving ESAs have an increased risk of thromboembolic and cardiovascular events. We herein review the main meta-analyses published in the field, their strengths and weaknesses, their contribution to patient management and future perspectives for systematic reviews.
癌症及癌症治疗相关的贫血是恶性疾病治疗中的一个常见且重要的问题。传统上，输血被用于治疗严重的癌症相关性贫血。重组人红细胞生成素刺激剂（ESA）的短效和长效制剂提供了另一种治疗选择。多项研究和随后的荟萃分析表明，ESA 治疗可提高血红蛋白水平，并降低部分治疗患者输血的可能性。然而，试图评估 ESA 是否改善肿瘤反应和生存的研究产生了相互矛盾的证据。较小的试验报告了改善的生存结果，而大型随机对照试验则报告了接受 ESA 治疗的患者死亡人数更多，这与较小的试验结果相矛盾。此外，有强有力的证据表明，接受 ESA 治疗的癌症患者发生血栓栓塞和心血管事件的风险增加。本文综述了该领域发表的主要荟萃分析，包括它们的优势和局限性、对患者管理的贡献以及系统综述的未来展望。
