Wang Qiang, Du Tao, Lu Changyou
aDepartment of General Surgery, E District, The First People's Hospital of Yibin, Yibin bDepartment of Nephrology, The Third Hospital of Mianyang, Mianyang, Sichuan Province, China.
Eur J Gastroenterol Hepatol. 2016 Nov;28(11):1233-40. doi: 10.1097/MEG.0000000000000706.
Several studies have reported different results on the association between perioperative blood transfusion (PBT) and clinical outcomes for patients undergoing cholangiocarcinoma surgery. So far, no systematic review and meta-analysis have focused on this inconsistent issue. Therefore, we carried out a systematic review and meta-analysis to evaluate the association between PBT and the clinical outcomes of cholangiocarcinoma surgery patients. EMBASE, PubMed, Web of Science, and the Cochrane Library were searched from their inception to 6 April 2016 to evaluate the relationship between PBT and clinical outcomes for patients undergoing cholangiocarcinoma surgery. The pooled hazard ratio (HR) with a 95% confidence interval (CI) was calculated using the Cochrane Collaboration's RevMan 5.3 software. A total of 10 studies (1719 patients) were included in the meta-analysis. Pooled analysis showed that PBT was associated with worse 5-year survival rate (HR=1.67, 95% CI=1.41-1.98, P<0.0001) and median overall survival (OS) (HR=1.45, 95% CI=1.14-1.83, P=0.002) in the patients who underwent cholangiocarcinoma surgery. Subgroup analysis showed that intraoperative blood transfusion was also associated with worse 5-year survival rate (HR=1.95, 95% CI=1.49-2.57, P<0.00001). Intraoperative blood transfusion is associated with poor OS for patients undergoing cholangiocarcinoma surgery because it will increase the risk of death. Postoperative blood transfusion may not be associated with OS. In addition, the relationship between PBT and the postoperative complication rate of cholangiocarcinoma surgery is still unclear.
多项研究报告了围手术期输血（PBT）与胆管癌手术患者临床结局之间的不同关联结果。到目前为止，尚无系统评价和荟萃分析关注这一不一致的问题。因此，我们进行了一项系统评价和荟萃分析，以评估PBT与胆管癌手术患者临床结局之间的关联。检索了EMBASE、PubMed、Web of Science和Cochrane图书馆，时间从其创建至2016年4月6日，以评估PBT与胆管癌手术患者临床结局之间的关系。使用Cochrane协作网的RevMan 5.3软件计算合并风险比（HR）及95%置信区间（CI）。荟萃分析共纳入10项研究（1719例患者）。汇总分析显示，PBT与胆管癌手术患者较差的5年生存率（HR=1.67，95%CI=1.41-1.98，P<0.0001）和中位总生存期（OS）（HR=1.45，95%CI=1.14-1.83，P=0.002）相关。亚组分析显示，术中输血也与较差的5年生存率相关（HR=1.95，95%CI=1.49-2.57，P<0.00001）。术中输血与胆管癌手术患者的OS较差相关，因为它会增加死亡风险。术后输血可能与OS无关。此外，PBT与胆管癌手术术后并发症发生率之间的关系仍不清楚。
