TY - JOUR
T1 - The prognostic role of perioperative allogeneic blood transfusions in gastric cancer patients undergoing curative resection: A systematic review and meta-analysis of non-randomized, adjusted studies
AU - Agnes, Annamaria
AU - Lirosi, Maria Carmen
AU - Panunzi, Simona
AU - Santocchi, Pietro
AU - Persiani, Roberto
AU - D'Ugo, Domenico
PY - 2018
Y1 - 2018
N2 - The impact of allogeneic perioperative blood transfusions (APTs) on the prognosis of gastric cancer patients undergoing curative-intent gastrectomy is still a highly debated topic. Two meta-analyses were published in 2015, and new studies report conflicting results. A literature review was conducted using PubMed, Scopus, the Cochrane Central Register of Controlled Trials and the Cochrane Database of Systematic Reviews, updated to March 1, 2016. Thirty-eight non-randomized studies reporting data on overall survival (OS), disease-free survival (DFS), disease-specific survival (DSS) and postoperative complications (PCs) were included. An inverse variance random-effects meta-analysis was conducted. APTs showed an association with worse OS, DFS, DSS and an increased number of PCs. The hazard ratio (HR) for OS was 1.49, with a 95% confidence interval (95% CI) of 1.32–1.69 (p <.00001; Q-test p =.001, I-squared = 56%). After outlier exclusion, the HR for OS was 1.34 (95% CI = 1.23–1.45, p <.00001; Q-test p =.64, I-squared = 0%). The HR for DFS was 1.48 (95% CI = 1.18–1.86, p =.0007; Q-test p =.31, I-squared = 16%), and the HR for DSS was 1.66 (95% CI = 1.5–2.19, p =.0004; Q-test p =.96, I-squared = 0%). The odds ratio for PCs was 3.33 (95% CI = 2.10–5.29, p <.00001; Q-test p =.14, I-squared = 42%). This meta-analysis showed a significant association between transfusions and OS, DFS, DSS and PCs. The quality of the evidence was low. Aggregation, selection and selective reporting bias were detected. The biases shifted the results towards significance. Further studies using accurate adjustment methods are needed. Until such additional studies are performed, caution in administering transfusions and optimization of cancer patient blood management are warranted.
AB - The impact of allogeneic perioperative blood transfusions (APTs) on the prognosis of gastric cancer patients undergoing curative-intent gastrectomy is still a highly debated topic. Two meta-analyses were published in 2015, and new studies report conflicting results. A literature review was conducted using PubMed, Scopus, the Cochrane Central Register of Controlled Trials and the Cochrane Database of Systematic Reviews, updated to March 1, 2016. Thirty-eight non-randomized studies reporting data on overall survival (OS), disease-free survival (DFS), disease-specific survival (DSS) and postoperative complications (PCs) were included. An inverse variance random-effects meta-analysis was conducted. APTs showed an association with worse OS, DFS, DSS and an increased number of PCs. The hazard ratio (HR) for OS was 1.49, with a 95% confidence interval (95% CI) of 1.32–1.69 (p <.00001; Q-test p =.001, I-squared = 56%). After outlier exclusion, the HR for OS was 1.34 (95% CI = 1.23–1.45, p <.00001; Q-test p =.64, I-squared = 0%). The HR for DFS was 1.48 (95% CI = 1.18–1.86, p =.0007; Q-test p =.31, I-squared = 16%), and the HR for DSS was 1.66 (95% CI = 1.5–2.19, p =.0004; Q-test p =.96, I-squared = 0%). The odds ratio for PCs was 3.33 (95% CI = 2.10–5.29, p <.00001; Q-test p =.14, I-squared = 42%). This meta-analysis showed a significant association between transfusions and OS, DFS, DSS and PCs. The quality of the evidence was low. Aggregation, selection and selective reporting bias were detected. The biases shifted the results towards significance. Further studies using accurate adjustment methods are needed. Until such additional studies are performed, caution in administering transfusions and optimization of cancer patient blood management are warranted.
KW - Blood transfusions
KW - Confounding
KW - Gastrectomy
KW - Gastric cancer
KW - Meta-analysis
KW - Oncology
KW - Surgery
KW - Blood transfusions
KW - Confounding
KW - Gastrectomy
KW - Gastric cancer
KW - Meta-analysis
KW - Oncology
KW - Surgery
UR - https://publicatt.unicatt.it/handle/10807/121777
U2 - 10.1016/j.ejso.2018.01.006
DO - 10.1016/j.ejso.2018.01.006
M3 - Article
SN - 0748-7983
VL - 44
SP - 404
EP - 419
JO - European Journal of Surgical Oncology
JF - European Journal of Surgical Oncology
IS - 4
ER -