Xun Yangqin, Tian Hongwei, Hu Lidong, Yan Peijing, Yang Kehu, Guo Tiankang
School of Public Health.
Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University.
Medicine (Baltimore). 2018 Oct;97(43):e12911. doi: 10.1097/MD.0000000000012911.
This meta-analysis aims to clarify the clinical impacts of allogeneic blood transfusion (ABT) on hepatectomy outcome in hepatocellular carcinoma (HCC) patients. A systematic literature search was performed for relevant articles in international and Chinese databases up to May 2018. Random- or fixed-effect meta-analysis was used to pool the effect estimates. Publication bias was assessed by Egger's and Peters's test. Heterogeneity was assessed using the I statistic. The strength of evidence was rated by the Grading of Recommendations Assessment, Development, and Evaluation system. A total of 29 studies met the eligibility criteria. Meta-analysis showed HCC patients in ABT group had lower survival rate at 1, 3, 5, and 10 years after radical hepatectomy than those in no blood transfusion (NBT) group (RR = 0.9, 95%CI: 0.87-0.93, P < .05; RR = 0.83, 95%CI: 0.77-0.89, P < .05; RR = 0.7, 95%CI: 0.65-0.74, P < .05; RR = 0.64, 95%CI: 0.54-0.75, P < .05). Similar results were observed in disease-free survival (DFS) (respectively: RR = 0.86, 95%CI: 0.82-0.91, P < .05; RR = 0.77, 95%CI: 0.67-0.79, P < .05; RR = 0.71, 95%CI: 0.64-0.79, P < .05; RR = 0.62, 95%CI: 0.48-0.8, P < .05). Cancer recurrence rate was higher for the patients in ABT group at 1 and 3 years (RR = 1.5, 95%CI: 1-2.24, P < .05; RR = 1.27, 95%CI: 1.09-1.49, P < .05, respectively), but not statistically significant at 5years (RR = 1.08, 95%CI: 0.98-1.19, P = .512). The HCC patients in ABT group increased postoperative complications occurrence compared with those in NBT group (RR = 1.87, 95%CI: 1.42-2.45, P < .05). This meta-analysis demonstrated that ABT was associated with adverse clinical outcomes for HCC patients undergoing radical hepatectomy, including poor survival, DFS, and complications. Surgeons should reduce blood loss during hepatectomy and avoid perioperative allogenic blood transfusion.
本荟萃分析旨在阐明同种异体输血（ABT）对肝细胞癌（HCC）患者肝切除术后结局的临床影响。截至2018年5月，我们在国际和中文数据库中对相关文章进行了系统的文献检索。采用随机或固定效应荟萃分析来汇总效应估计值。通过Egger检验和Peters检验评估发表偏倚。使用I统计量评估异质性。证据强度由推荐分级评估、制定和评价系统进行评级。共有29项研究符合纳入标准。荟萃分析显示，ABT组的HCC患者在根治性肝切除术后1年、3年、5年和10年的生存率低于未输血（NBT）组（RR = 0.9，95%CI：0.87 - 0.93，P <.05；RR = 0.83，95%CI：0.77 - 0.89，P <.05；RR = 0.7，95%CI：0.65 - 0.74，P <.05；RR = 0.64，95%CI：0.54 - 0.75，P <.05）。无病生存期（DFS）也观察到类似结果（分别为：RR = 0.86，95%CI：0.82 - 0.91，P <.05；RR = 0.77，95%CI：0.67 - 0.79，P <.05；RR = 0.71，95%CI：0.64 - 0.79，P <.05；RR = 0.62，95%CI：0.48 - 0.8，P <.05）。ABT组患者在1年和3年时的癌症复发率较高（RR = 1.5，95%CI：1 - 2.24，P <.05；RR = 1.27，95%CI：1.09 - 1.
