围手术期输血对肾细胞癌肾切除术后生存的影响：一项系统评价和荟萃分析。
The effect of perioperative blood transfusion on survival after renal cell carcinoma nephrectomy: A systematic review and meta-analysis.
作者信息
Liu Yang, Deng Xianzhong, Wen Zhi, Huang Jing, Wang Chongjian, Chen Caixia, Yang Xuesong
机构信息
Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China.
Department of Urology, Chengdu Xinhua Hospital Affiliated to North Sichuan Medical College, Chengdu, China.
出版信息
Front Oncol. 2023 Feb 16;13:1092734. doi: 10.3389/fonc.2023.1092734. eCollection 2023.
BACKGROUND
The effect of perioperative blood transfusion (PBT) on postoperative survival in RCC patients who underwent partial nephrectomy (PN) or radical nephrectomy (RN) remains controversial. Two meta-analyses in 2018 and 2019 reported the postoperative mortality of PBT patients with RCC, but they did not investigate the effect on the survival of patients. We performed a systematic review and meta-analysis of relevant literature to demonstrate whether PBT affected postoperative survival in RCC patients who received nephrectomy.
METHODS
Pubmed, Web of Science, Cochrane, and Embase databases were searched. Studies comparing RCC patients with or without PBT following either RN or PN were included in this analysis. Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of the included literature, and hazard ratios (HRs) of overall survival (OS), recurrence-free survival (RFS), and cancer-specific survival (CSS), as well as 95% confidence intervals, were considered as effect sizes. All data were processed using Stata 15.1.
RESULTS
Ten retrospective studies involving 19,240 patients were included in this analysis, with the publication dates ranging from 2014 to 2022. Evidence revealed that PBT was significantly associated with the decline of OS (HR, 2.62; 95%CI: 1,98-3.46), RFS (HR, 2.55; 95%CI: 1.74-3.75), and CSS (HR, 3.15; 95%CI: 2.3-4.31) values. There was high heterogeneity among the study results due to the retrospective nature and the low quality of the included studies. Subgroup analysis findings suggested that the heterogeneity of this study might be caused by different tumor stages in the included articles. Evidence implied that PBT had no significant influence on RFS and CSS with or without robotic assistance, but it was still linked to worse OS (combined HR; 2.54 95% CI: 1.18, 5.47). Furthermore, the subgroup analysis with intraoperative blood loss lower than 800 ML revealed that PBT had no substantial impact on OS and CSS of postoperative RCC patients, whereas it was correlated with poor RFS (1.42, 95% CI: 1.02-1.97).
CONCLUSIONS
RCC patients undergoing PBT after nephrectomy had poorer survival.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022363106.
背景
围手术期输血（PBT）对接受部分肾切除术（PN）或根治性肾切除术（RN）的肾细胞癌（RCC）患者术后生存的影响仍存在争议。2018年和2019年的两项荟萃分析报告了RCC患者围手术期输血后的术后死亡率，但未研究其对患者生存的影响。我们对相关文献进行了系统综述和荟萃分析，以证明PBT是否影响接受肾切除术的RCC患者的术后生存。
方法
检索了PubMed、Web of Science、Cochrane和Embase数据库。本分析纳入了比较接受RN或PN后有或无PBT的RCC患者的研究。采用纽卡斯尔-渥太华量表（NOS）评估纳入文献的质量，并将总生存期（OS）、无复发生存期（RFS）和癌症特异性生存期（CSS）的风险比（HR）以及95%置信区间作为效应量指标。所有数据均使用Stata 15.1进行处理。
结果
本分析纳入了10项回顾性研究，共19240例患者，发表时间从2014年至2022年。证据显示，PBT与OS（HR，2.62；95%CI：1.98 - 3.46）、RFS（HR，2.55；95%CI：1.74 - 3.75）和CSS（HR，3.15；95%CI：2.3 - 4.31）值的下降显著相关。由于纳入研究的回顾性性质和低质量，研究结果之间存在高度异质性。亚组分析结果表明，本研究的异质性可能是由纳入文章中不同的肿瘤分期引起的。有证据表明，无论有无机器人辅助，PBT对RFS和CSS均无显著影响，但仍与较差的OS相关（合并HR；2.54，95%CI：1.18，5.47）。此外，术中失血低于800毫升的亚组分析显示，PBT对术后RCC患者的OS和CSS没有实质性影响，而与较差的RFS相关（1.42，95%CI：1.02 - 1.97）。
结论
肾切除术后接受PBT的RCC患者生存较差。
系统综述注册
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