Liu Yang, Bai Yun-Peng, Zhou Zi-Fang, Jiang Chang-Rui, Xu Zhe, Fan Xiao-Xi
Department of Thoracic Surgery, the First Affiliated Hospital of China Medical University, Shenyang, China.
J Cancer. 2019 May 12;10(9):2047-2056. doi: 10.7150/jca.29410. eCollection 2019.
The evidence of current epidemiological studies investigating the relationship between preoperative anemia and progression of lung cancer (LC) patients remains controversial. The PubMed, EMBASE, and Web of Science databases were comprehensively searched by two independent authors to identify related epidemiological studies from inception through January 31, 2019. Similarly, two researchers separately extracted data and any differences were resolved by discussion. Summarized hazard ratios (HRs) and 95% confidence intervals (CIs) were summarized with inverse variance weighted random effects meta-analysis. Heterogeneity among studies was assessed with the ² statistic. Twenty-two studies were included in this meta-analysis. As compared with LC patients without anemia, those with pre-operative anemia were at a 1.6-fold greater risk of death (summarized HR = 1.58; 95% CI = 1.44-1.75), with moderate heterogeneity ( = 53.1%). Funnel plot and statistical analyses showed no evidence of publication bias. Associations between pre-operative anemia and OS were broadly consistent across numerous subgroups analyses stratified by the study design, geographic location, number of cases, tumor, node, and metastasis (TNM) stage, histology, quality, and adjustment for potential confounders (age, sex, body mass index, TNM stage, histology, performance status, surgery, blood transfusion, and systemic inflammatory response markers). Similar patterns were observed in the sensitivity analyses. The results of meta-regression analysis suggested no evidence of significant heterogeneity between subgroups. In conclusion, pre-operative anemia was associated with poorer overall survival among LC patients.
目前关于术前贫血与肺癌（LC）患者病情进展之间关系的流行病学研究证据仍存在争议。两名独立作者全面检索了PubMed、EMBASE和Web of Science数据库，以识别从研究开始至2019年1月31日的相关流行病学研究。同样，两名研究人员分别提取数据，任何差异通过讨论解决。采用逆方差加权随机效应荟萃分析总结汇总风险比（HRs）和95%置信区间（CIs）。用²统计量评估研究间的异质性。本荟萃分析纳入了22项研究。与无贫血的LC患者相比，术前贫血患者的死亡风险高1.6倍（汇总HR = 1.58；95% CI = 1.44 - 1.75），异质性中等（ = 53.1%）。漏斗图和统计分析未显示发表偏倚的证据。在按研究设计、地理位置、病例数、肿瘤、淋巴结和转移（TNM）分期、组织学、质量以及对潜在混杂因素（年龄、性别、体重指数、TNM分期、组织学、体能状态、手术、输血和全身炎症反应标志物）进行调整分层的众多亚组分析中，术前贫血与总生存期之间的关联大致一致。敏感性分析中观察到类似模式。荟萃回归分析结果表明亚组间无显著异质性证据。总之，术前贫血与LC患者较差的总生存期相关。
