Churchhouse Antonia M D, Mathews Timothy J, McBride Olivia M B, Dunning Joel
Department of Cardiothoracic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK.
Interact Cardiovasc Thorac Surg. 2012 Jan;14(1):85-90. doi: 10.1093/icvts/ivr025. Epub 2011 Nov 15.
A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether blood transfusion increases the chance of recurrence in patients undergoing surgery for lung cancer. Altogether 468 papers were found using the reported search, of which 21 represented the best evidence to answer the clinical question. The authors, journal date and country of publication, patient group studied, study type, relevant outcomes and results of these papers were tabulated. Nineteen cohort studies (two of which examined the same or similar data sets as two other studies already included), one comment article and one meta-analysis were identified. In total, the outcomes of 5378 patients undergoing surgical resection for lung cancer were analysed. The transfusion rate varied between 15 and 67%. The primary endpoints in all 21 papers were recurrence, survival or disease-free survival. We conclude that the research undertaken to examine the relationship between blood transfusion and lung cancer recurrence, survival and disease-free survival comes to no definite conclusion. Half of the papers relating to recurrence state that there is no significantly increased risk of recurrence with transfusion, whereas the other half state that there is. However, four of the five papers examining disease-free survival demonstrate a significant adverse relationship between this primary outcome and blood transfusion. With regard to survival, five of the papers reviewed showed no effect of blood transfusion, whereas five showed some form of adverse effect. Although there is no overwhelming agreement among the presented evidence, there is a slightly larger body of evidence supporting the theory that blood transfusions are associated with poorer outcomes in patients undergoing resection for lung cancer. However, whether this is a direct effect, or a surrogate marker for other factors such as anaemia, is unclear.
根据结构化方案撰写了一篇胸外科最佳证据主题文章。所探讨的问题是，输血是否会增加肺癌手术患者的复发几率。通过报告的检索共找到468篇论文，其中21篇代表了回答该临床问题的最佳证据。将这些论文的作者、期刊日期、出版国家、所研究的患者组、研究类型、相关结局和结果制成表格。确定了19项队列研究（其中两项研究的数据与已纳入的另外两项研究相同或相似）、一篇评论文章和一篇荟萃分析。总共分析了5378例接受肺癌手术切除患者的结局。输血率在15%至67%之间。所有21篇论文的主要终点均为复发、生存率或无病生存率。我们得出结论，关于输血与肺癌复发、生存率和无病生存率之间关系的研究未得出明确结论。关于复发的论文中有一半指出输血不会显著增加复发风险，而另一半则表示会增加。然而，在五项研究无病生存率的论文中，有四项表明这一主要结局与输血之间存在显著的不利关系。关于生存率，所审查的论文中有五篇显示输血无影响，而有五篇显示了某种形式的不利影响。尽管现有证据并未达成压倒性的一致，但有稍多一些的证据支持这样一种理论，即输血与肺癌切除患者的较差结局相关。然而，这是直接影响，还是诸如贫血等其他因素的替代指标，尚不清楚。
