From the Department of Surgery, David Geffen School of Medicine at UCLA.
Louise M. Darling Biomedical Library, UCLA, Los Angeles, CA.
Pancreas. 2021;50(5):648-656. doi: 10.1097/MPA.0000000000001825.
To evaluate survival outcomes associated with perioperative allogeneic red blood cell transfusion (RBCT) in patients with pancreatic ductal adenocarcinoma undergoing surgery.
PubMed, Embase, Cochrane, and Web of Science Core Collection were queried for English-language articles until May 28, 2020. Studies evaluating long-term outcomes of RBCT compared with no transfusion in adults with pancreatic ductal adenocarcinoma undergoing pancreatectomy were included. E-value sensitivity analysis assessed the potential for unmeasured confounders to overcome these findings.
Of 4379 citations, 5 retrospective cohort studies were included. Three studies reported shorter recurrence-free survival by 1 to 5 months with RBCT. Two studies found shorter disease-specific survival by 5 to 13 months with RBCT. Overall survival was reduced by 5 to 7 months with RBCT in 3 studies. All multivariable findings associated with RBCT could be readily overcome unmeasured confounding on sensitivity analysis. Confounding in baseline characteristics resulted in high risk of bias.
Imprecision, unmeasured confounding, small effect sizes, and overall low quality of the available literature result in uncertainty regarding the effect of transfusion on recurrence-free survival, disease-specific survival, and overall survival in patients undergoing surgery for pancreatic cancer. Randomized trials are needed to determine if there is a causal relationship between transfusion and survival after pancreatic resection.
评估接受手术治疗的胰腺导管腺癌患者围手术期异体红细胞输血 (RBCT) 与生存结局的相关性。
检索 PubMed、Embase、Cochrane 和 Web of Science Core Collection 中的英文文献，检索时间截至 2020 年 5 月 28 日。纳入评估 RBCT 与胰腺切除术成人患者无输血相比的长期结局的研究。敏感性分析 E 值评估潜在的未测量混杂因素对这些发现的影响。
在 4379 条引文中有 5 项回顾性队列研究被纳入。有 3 项研究报告 RBCT 使无复发生存率缩短了 1 至 5 个月。有 2 项研究发现 RBCT 使疾病特异性生存率缩短了 5 至 13 个月。有 3 项研究发现 RBCT 使总生存率缩短了 5 至 7 个月。在敏感性分析中，所有与 RBCT 相关的多变量发现都可以轻易地克服未测量的混杂因素。在基线特征中存在混杂因素导致存在高偏倚风险。
由于证据的不精确性、未测量的混杂因素、小的效应大小以及现有文献的总体低质量，对于输血对接受胰腺癌手术患者的无复发生存率、疾病特异性生存率和总生存率的影响存在不确定性。需要进行随机试验来确定输血与胰腺切除术后的生存之间是否存在因果关系。
