Xia Leilei, Guzzo Thomas J
Division of Urology, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
Division of Urology, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
Clin Genitourin Cancer. 2017 Apr;15(2):263-272.e4. doi: 10.1016/j.clgc.2016.08.017. Epub 2016 Aug 29.
The aim of this study was to determine the effect of preoperative anemia status and hemoglobin level on clinical outcomes in patients with bladder cancer undergoing radical cystectomy.
A systematic review of literature with meta-analyses of predefined outcomes based on a search of PubMed and EMBASE was performed. Hazard ratios (HRs) measuring the association between preoperative anemia/hemoglobin and all-cause mortality, cancer-specific mortality, and disease recurrence were calculated with random effects model. Study heterogeneities were quantified by I tests. Publication bias was assessed with funnel plots.
A total of 17 studies evaluating the impact of preoperative anemia status (categorical, 11 studies) and hemoglobin level (continuous, 7 studies) on clinical outcomes were included. The cutoff value of anemia varied among studies (10.5-13.5 g/dL for male, 10.5-13.4 g/dL for female). Meta-analyses showed that compared with non-anemia, anemia was associated with increased all-cause mortality (HR, 1.75; 95% confidence interval [CI], 1.48-2.05; P < .00001; I = 30%), cancer-specific mortality (HR, 1.80; 95% CI, 1.45-2.25; P < .00001; I = 26%), and disease recurrence (HR, 1.37; 95% CI, 1.16-1.62; P = .0002; I = 9%). Meta-analyses showed that higher level of hemoglobin was associated with decreased all-cause mortality (HR, 0.90; 95% CI, 0.87-0.92; P < .00001; I = 13%), cancer-specific mortality (HR, 0.90; 95% CI, 0.85-0.95; P = .0003; I = 61%), and disease recurrence (HR, 0.95; 95% CI, 0.91-0.99; P = .01; I = 53%). No obvious publication bias was observed.
Preoperative anemia and low hemoglobin level are associated with earlier recurrence and shorter survival of patients with bladder cancer undergoing radical cystectomy. However, well-designed prospective studies with large sample size and limited confounding factors are needed to confirm and update our findings.
本研究旨在确定术前贫血状态和血红蛋白水平对接受根治性膀胱切除术的膀胱癌患者临床结局的影响。
基于对PubMed和EMBASE的检索，对文献进行系统评价并对预定义结局进行荟萃分析。采用随机效应模型计算衡量术前贫血/血红蛋白与全因死亡率、癌症特异性死亡率和疾病复发之间关联的风险比（HRs）。通过I检验对研究异质性进行量化。用漏斗图评估发表偏倚。
共纳入17项评估术前贫血状态（分类变量，11项研究）和血红蛋白水平（连续变量，7项研究）对临床结局影响的研究。不同研究中贫血的临界值有所不同（男性为10.5 - 13.5 g/dL，女性为10.5 - 13.4 g/dL）。荟萃分析表明，与非贫血相比，贫血与全因死亡率增加相关（HR，1.75；95%置信区间[CI]，1.48 - 2.05；P <.00001；I = 30%）、癌症特异性死亡率增加相关（HR，1.80；95% CI，1.45 - 2.25；P <.00001；I = 26%）以及疾病复发相关（HR，1.37；95% CI，1.16 - 1.62；P =.0002；I = 9%）。荟萃分析表明，较高的血红蛋白水平与全因死亡率降低相关（HR，0.90；95% CI，0.87 - 0.92；P <.00001；I = 13%）、癌症特异性死亡率降低相关（HR，0.90；95% CI，0.85 - 0.95；P =.0003；I = 61%）以及疾病复发降低相关（HR，0.95；95% CI，0.91 - 0.99；P =.01；I = 53%）。未观察到明显的发表偏倚。
术前贫血和低血红蛋白水平与接受根治性膀胱切除术的膀胱癌患者更早复发和更短生存期相关。然而，需要设计良好、样本量大且混杂因素有限的前瞻性研究来证实和更新我们的发现。
