肝细胞癌肝移植术中血液回收自体输血的临床预后：系统评价与Meta分析
Clinical prognosis of intraoperative blood salvage autotransfusion in liver transplantation for hepatocellular carcinoma: A systematic review and meta-analysis.
作者信息
Wang Zheng, Li Saixin, Jia Yitong, Liu Miao, Yang Kun, Sui Minghao, Liu Dongbin, Liang Kuo
机构信息
Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, China.
出版信息
Front Oncol. 2022 Oct 18;12:985281. doi: 10.3389/fonc.2022.985281. eCollection 2022.
BACKGROUND
Intraoperative blood salvage autotransfusion(IBSA) has been widely used in a variety of surgeries, but the use of IBSA in hepatocellular carcinoma (HCC) patients undergoing liver transplantation (LT) is controversial. Numerous studies have reported that IBSA used during LT for HCC is not associated with adverse oncologic outcomes. This systematic review and meta-analysis aims to estimate the clinical prognosis of IBSA for patients with H+CC undergoing LT.
METHODS
MEDLINE, Embase, Web of Science, and Cochrane Library were searched for articles describing IBSA in HCC patients undergoing LT from the date of inception until May 1, 2022, and a meta-analysis was performed. Study heterogeneity was assessed by I test. Publication bias was evaluated by funnel plots, Egger's and Begg's test.
RESULTS
12 studies enrolling a total of 2253 cases (1374 IBSA and 879 non-IBSA cases) are included in this meta-analysis. The recurrence rate(RR) at 5-year(OR=0.75; 95%CI, 0.59-0.95; P=0.02) and 7-year(OR=0.65; 95%CI, 0.55-0.97; P=0.03) in the IBSA group is slightly lower than non-IBSA group. There are no significant differences in the 1-year RR(OR=0.77; 95% CI, 0.56-1.06; P=0.10), 3-years RR (OR=0.79; 95% CI, 0.62-1.01; P=0.06),1-year overall survival outcome(OS) (OR=0.90; 95% CI, 0.63-1.28; P=0.57), 3-year OS(OR=1.16; 95% CI, 0.83-1.62; P=0.38), 5-year OS(OR=1.04; 95% CI, 0.76-1.40; P=0.82),1-year disease-free survival rate(DFS) (OR=0.80; 95%CI, 0.49-1.30; P=0.36), 3-year DFS(OR=0.99; 95%CI, 0.64-1.55; P=0.98), and 5-year DFS(OR=0.88; 95%CI, 0.60-1.28; P=0.50). Subgroup analysis shows a difference in the use of leukocyte depletion filters group of 5-year RR(OR=0.73; 95%CI, 0.55-0.96; P=0.03). No significant differences are found in other subgroups.
CONCLUSIONS
IBSA provides comparable survival outcomes relative to allogeneic blood transfusion and does not increase the tumor recurrence for HCC patients after LT.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/, identifier CRD42022295479.
背景
术中血液回收自体输血（IBSA）已广泛应用于各种手术，但IBSA在接受肝移植（LT）的肝细胞癌（HCC）患者中的应用存在争议。大量研究报告称，LT期间用于HCC的IBSA与不良肿瘤学结局无关。本系统评价和荟萃分析旨在评估IBSA用于接受LT的HCC患者的临床预后。
方法
检索MEDLINE、Embase、Web of Science和Cochrane图书馆，查找自数据库建立至2022年5月1日描述IBSA在接受LT的HCC患者中的应用的文章，并进行荟萃分析。通过I检验评估研究异质性。通过漏斗图、Egger检验和Begg检验评估发表偏倚。
结果
本荟萃分析纳入了12项研究，共2253例患者（1374例IBSA组和879例非IBSA组）。IBSA组5年（OR = 0.75；95%CI，0.59 - 0.95；P = 0.02）和7年（OR = 0.65；95%CI，0.55 - 0.97；P = 0.03）的复发率略低于非IBSA组。1年复发率（OR = 0.77；95%CI，0.56 - 1.06；P = 0.10）、3年复发率（OR = 口79；95%CI，0.62 - 1.01；P = 0.06）、1年总生存结局（OS）（OR = 0.90；95%CI，0.63 - 1.28；P = 0.57）、3年OS（OR = 1.16；95%CI，0.83 - 1.62；P = 0.38）、5年OS（OR = 1.04；95%CI，0.76 - 1.40；P = 0.82）、1年无病生存率（DFS）（OR = 0.80；95%CI，0.49 - 1.30；P = 0.36）、3年DFS（OR = 0.9口；95%CI，0.64 -口55；P = 0.98）和5年DFS（OR = 0.88；95%CI，0.60 - 1.28；P = 0.50）方面无显著差异。亚组分析显示，使用白细胞滤除器组的5年复发率存在差异（OR = 0.73；95%CI，0.55 - 0.96；P = 0.03）。其他亚组未发现显著差异。
结论
与异体输血相比，IBSA为LT术后的HCC患者提供了相当的生存结局，且不会增加肿瘤复发风险。
系统评价注册
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