输血可能对肺癌患者的生存结果产生不利影响：一项系统评价和荟萃分析。
Blood transfusions may adversely affect survival outcomes of patients with lung cancer: a systematic review and meta-analysis.
作者信息
Cho Sukjoo, Park Jonghanne, Lee Misuk, Lee Dongyup, Choi Horyun, Gim Gahyun, Kim Leeseul, Kang Cyra Y, Oh Youjin, Viveiros Pedro, Vagia Elena, Oh Michael S, Cho Geum Joon, Bharat Ankit, Chae Young Kwang
机构信息
Department of Pediatrics, University of South Florida Morsani College of Medicine, Tampa, FL, USA.
Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
出版信息
Transl Lung Cancer Res. 2021 Apr;10(4):1700-1710. doi: 10.21037/tlcr-20-933.
BACKGROUND
Despite common use in clinical practice, the impact of blood transfusions on prognosis among patients with lung cancer remains unclear. The purpose of the current study is to perform an updated systematic review and meta-analysis to evaluate the influence of blood transfusions on survival outcomes of lung cancer patients.
METHODS
We searched PubMed, Embase, Cochrane Library, and Ovid MEDLINE for publications illustrating the association between blood transfusions and prognosis among people with lung cancer from inception to November 2019. Overall survival (OS) and disease-free survival (DFS) were the outcomes of interest. Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were computed using the random-effects model. Study heterogeneity was evaluated with the I test. Publication bias was explored via funnel plot and trim-and-fill analyses.
RESULTS
We included 23 cohort studies with 12,175 patients (3,027 cases and 9,148 controls) for meta-analysis. Among these records, 22 studies investigated the effect of perioperative transfusions, while one examined that of transfusions during chemotherapy. Two studies suggested the possible dose-dependent effect in accordance with the number of transfused units. In pooled analyses, blood transfusions deleteriously influenced both OS (HR=1.35, 95% CI: 1.14-1.61, P<0.001, I=0%) and DFS (HR=1.46, 95% CI: 1.15-1.86, P=0.001, I=0%) of people with lung cancer. No evidence of significant publication bias was detected in funnel plot and trim-and-fill analyses (OS: HR=1.26, 95% CI: 1.07-1.49, P=0.006; DFS: HR=1.35, 95% CI: 1.08-1.69, P=0.008).
CONCLUSIONS
Blood transfusions were associated with decreased survival of patients with lung cancer.
背景
尽管输血在临床实践中常用，但输血对肺癌患者预后的影响仍不明确。本研究的目的是进行一项更新的系统评价和荟萃分析，以评估输血对肺癌患者生存结局的影响。
方法
我们检索了PubMed、Embase、Cochrane图书馆和Ovid MEDLINE，以查找从开始到2019年11月期间阐述输血与肺癌患者预后之间关联的出版物。总生存期（OS）和无病生存期（DFS）是感兴趣的结局。采用随机效应模型计算合并风险比（HRs）及95%置信区间（CIs）。使用I²检验评估研究异质性。通过漏斗图和修剪填充分析探索发表偏倚。
结果
我们纳入了23项队列研究，共12175例患者（3027例病例和9148例对照）进行荟萃分析。在这些记录中，22项研究调查了围手术期输血的影响，而1项研究了化疗期间输血的影响。两项研究表明，根据输血单位数量可能存在剂量依赖性效应。在汇总分析中，输血对肺癌患者的总生存期（HR = 1.35，95% CI：1.14 - 1.61，P < 0.001，I² = 0%）和无病生存期（HR = 1.46，95% CI：1.15 - 1.86，P = 0.001，I² = 0%）均有不利影响。在漏斗图和修剪填充分析中未检测到显著发表偏倚的证据（总生存期：HR = 1.26，95% CI：1.07 - 1.49，P = 0.006；无病生存期：HR = 1.35，95% CI：1.08 - 1.69，P = 0.008）。
结论
输血与肺癌患者生存率降低有关。
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