Amato A C, Pescatori M
Coloproctology Unit, Villa Flaminia, Rome, Italy.
Dis Colon Rectum. 1998 May;41(5):570-85. doi: 10.1007/BF02235262.
This study was undertaken to evaluate the influence of perioperative blood transfusions on colorectal cancer recurrence.
All articles published up to December 1996 in English (or with an English abstract) were retrieved, both using MEDLINE and scanning their references, to be considered for this meta-analysis.
One hundred thirty-one articles were identified, and 99 of them were excluded because they analyzed survival or mortality, were repetitive publications, or were reviews or letters. Thirty-two original studies (9 were prospective) on 11,071 patients were included for further analysis; 20 showed a detrimental effect of perioperative blood transfusions. Nineteen articles used also multivariable techniques, and 11 found perioperative blood transfusions to be an independent prognostic factor. Pooled estimates of the effect of perioperative blood transfusions on colorectal cancer recurrence yielded an overall odds ratio of 1.68 (95 percent confidence interval, 1.54-1.83) and a rate difference of 0.13 (95 percent confidence interval, 0.09-0.17) against patients who received transfusions. Stratified meta-analyses also confirmed these findings when stratifying patients by site and stage of disease. The effect of perioperative blood transfusion was observed in a dose-related fashion, regardless of timing and type, although some heterogeneity was detected. Data on surgical techniques were not available for further analysis.
A consistently detrimental association was discovered between the use of perioperative blood transfusion and colorectal cancer recurrence. Further studies are needed to confirm that blood transfusion has a causal association.
本研究旨在评估围手术期输血对结直肠癌复发的影响。
检索截至1996年12月发表的所有英文文章（或带有英文摘要），通过MEDLINE检索并查阅其参考文献，以纳入本荟萃分析。
共识别出131篇文章，其中99篇被排除，原因包括分析生存或死亡率、重复发表、综述或信函。纳入32项关于11071例患者的原始研究（9项为前瞻性研究）进行进一步分析；20项研究显示围手术期输血有不良影响。19篇文章还采用了多变量技术，其中11篇发现围手术期输血是一个独立的预后因素。围手术期输血对结直肠癌复发影响的合并估计显示，与接受输血的患者相比，总体比值比为1.68（95%置信区间，1.54 - 1.83），率差为0.13（95%置信区间，0.09 - 0.17）。按疾病部位和分期对患者进行分层的荟萃分析也证实了这些发现。尽管检测到一些异质性，但无论输血时间和类型如何，围手术期输血的影响均呈剂量相关。无法获取手术技术的数据进行进一步分析。
发现围手术期输血的使用与结直肠癌复发之间存在一致的不良关联。需要进一步研究以证实输血存在因果关系。
