Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, Jikei University School of Medicine, Tokyo, Japan.
Urol Oncol. 2019 Apr;37(4):273-281. doi: 10.1016/j.urolonc.2019.01.018. Epub 2019 Feb 6.
To investigate the association of perioperative blood transfusion (PBT) with oncologic outcomes in patients with renal cell carcinoma (RCC), we conducted a systematic review and meta-analysis of the literature to clarify the long-term oncologic effect of PBT in patients undergoing nephrectomy for RCC.
We searched the MEDLINE, Web of Science, Cochrane Library and Scopus on 15th April 2018 to identify studies that compared patients who received PBT undergoing radical or partial nephrectomy for RCC to patients who did not with the aim of evaluating its impact on overall mortality (OM), cancer-specific mortality (CSM) and disease recurrence using multivariable cox regression analysis.
A total of 19,681 patients in 7 studies matched the selection criteria for the systematic review and meta-analysis. All 7 studies were retrospective design and published between 1994 and 2018. Our study included low quality of eligible studies due to their retrospective design and showed a significant heterogeneity. PBT was associated with OM (pooled hazard ratio [HR], 1.49, 1.24-1.78), CSM (pooled HR, 1.46, 1.20-1.77), and disease recurrence (pooled HR, 1.80, 1.03-3.12). In a subgroup analysis of 3,664 patients with nonmetastatic RCC, PBT was remained associated with OM (pooled HR, 1.91; 1.06-3.41), but not anymore with CSM (pooled HR, 1.92, 0.94-3.91) or disease recurrence (pooled HR, 2.18, 0.86-5.55).
PBT in patients undergoing nephrectomy for RCC is associated with worse overall survival. While PBT may be reflective of the underlying aggressiveness of the disease, it could be that its detrimental effect on outcomes is caused by its negative effect on the host's resilience.
为了研究围手术期输血（PBT）与肾细胞癌（RCC）患者的肿瘤学结局之间的关系，我们对文献进行了系统回顾和荟萃分析，以明确 PBT 在接受肾切除术治疗 RCC 的患者中的长期肿瘤学效应。
我们于 2018 年 4 月 15 日在 MEDLINE、Web of Science、Cochrane Library 和 Scopus 上进行了检索，以确定将接受 PBT 并接受根治性或部分肾切除术治疗 RCC 的患者与未接受 PBT 治疗的患者进行比较的研究，目的是使用多变量 Cox 回归分析评估其对总死亡率（OM）、癌症特异性死亡率（CSM）和疾病复发的影响。
共有 7 项研究的 19681 例患者符合系统评价和荟萃分析的选择标准。所有 7 项研究均为回顾性设计，发表于 1994 年至 2018 年之间。由于我们的研究是回顾性设计，因此研究质量较低，且显示出显著的异质性。PBT 与 OM（合并危险比[HR]，1.49，1.24-1.78）、CSM（合并 HR，1.46，1.20-1.77）和疾病复发（合并 HR，1.80，1.03-3.12）相关。在对 3664 例非转移性 RCC 患者的亚组分析中，PBT 仍然与 OM 相关（合并 HR，1.91；1.06-3.41），但与 CSM 无关（合并 HR，1.92，0.94-3.91）或疾病复发（合并 HR，2.18，0.86-5.55）。
在接受肾切除术治疗 RCC 的患者中，PBT 与总体生存率较差相关。虽然 PBT 可能反映了疾病的潜在侵袭性，但也可能是其对宿主恢复力的负面影响导致了对结局的不利影响。
