The Effect of Perioperative Blood Transfusion on Long-Term Survival Outcomes After Surgery for Pancreatic Ductal Adenocarcinoma: A Systematic Review.
The Effect of Perioperative Blood Transfusion on Long-Term Survival Outcomes After Surgery for Pancreatic Ductal Adenocarcinoma: A Systematic Review.
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DOI：
10.1097/mpa.0000000000001825
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发表时间：
2021-05-01
期刊：
影响因子：
2.9
通讯作者：
Hines OJ
中科院分区：
文献类型：
--
作者：
Ye L;Livingston EH;Myers B;Hines OJ
评估接受手术的胰腺导管腺癌患者围手术期异体红细胞输注（RBCT）相关的生存结局。查询PubMed、Embase、科克伦和Web of Science中的英文文章，直至2020年5月28日。纳入了评价RBCT与不输血相比在接受胰腺切除术的成人胰腺导管腺癌患者中的长期结局的研究。E值敏感性分析评估了未测量混杂因素克服这些结果的可能性。在4379篇引文中，纳入了5项回顾性队列研究。3项研究报告RBCT的无复发生存期缩短1-5个月。两项研究发现，RBCT的疾病特异性生存期缩短5-13个月。在三项研究中，RBCT的总生存期缩短了5-7个月。所有与RBCT相关的多变量结果都可以很容易地克服敏感性分析中的未测量混杂因素。基线特征的混杂导致偏倚风险高。现有文献的不精确性、未测量的混杂因素、较小的效应量和总体质量较低，导致输血对接受胰腺癌手术患者的无复发生存期、疾病特异性生存期和总生存期的影响存在不确定性。需要进行随机试验来确定输血和胰腺切除术后生存率之间是否存在因果关系。
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 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 potential for unmeasured confounders to overcome these findings. Of 4379 citations, five retrospective cohort studies were included. Three studies reported shorter recurrence-free survival by 1–5 months with RBCT. Two studies found shorter disease-specific survival by 5–13 months with RBCT. Overall survival was reduced by 5–7 months with RBCT in three 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 following pancreatic resection.