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目的分析接受根治性膀胱切除患者围手术期输血与无复发生存率、肿瘤特异性生存率和总生存率之间的相关性。方法计算机检索Pub Med、EMbase、Cochrane Library、Clinical Trials.gov、CBM、CNKI和Wan Fang Data数据库,查找围手术期输血与膀胱癌手后临床结局相关性的随机对照试验、队列研究和病例对照研究,检索时限均为从建库-2015年12月。采用Cochrane偏倚风险工具和Ottawa-Newcastle量表分别评价纳入随机对照试验和队列研究/病例对照研究的方法学质量。结果共纳入8篇研究,结果显示围手术期输血增加总体死亡风险的相关性为27%(HR 1.27[1.15-1.40]),I2为68%。围手术期输血后的肿瘤特异性生存率比不输血组低29%(HR 1.29[1.13-1.46]),I2为61%。围手术期输血无复发生存率比不输血的要低21%(HR 1.21[1.12-1.31]),I2为0%。本文的局限性主要是纳入了队列研究和病例对照研究,其潜在的偏倚可能会夸大结果。结论围手术期输血与降低无复发生存率,肿瘤特异性生存率和总生存率存在显著相关性。但仍需要设计一些设计良好的前瞻性随机对照试验提供高质量的证据进一步论证该问题。
Objective To analyze the correlation between perioperative blood transfusion and recurrence-free survival, tumor-specific survival and overall survival in patients undergoing radical cystectomy. METHODS: Randomized controlled trials, cohort studies and case-control studies were performed using Pub Med, EMbase, Cochrane Library, Clinical Trials.gov, CBM, CNKI and Wan Fang Data to find out the correlation between perioperative blood transfusion and clinical outcomes of bladder cancer , The search time is from the library - December 2015. The Cochrane Bias Risk Tool and the Ottawa-Newcastle Scale were used to evaluate the methodological quality of inclusion in randomized controlled trials and cohort / case-control studies, respectively. Results A total of 8 studies were included and the correlation between perioperative blood transfusion and overall risk of death was 27% (HR 1.27 [1.15-1.40]) and I2 was 68%. Tumor-specific survival after perioperative blood transfusions was 29% lower (HR 1.29 [1.13-1.46]) than non-transfusions and I2 was 61%. Perinatal recurrence-free survival was 21% lower for transfusions (HR 1.21 [1.12-1.31]) and I2 was 0%. The limitations of this paper are mainly the inclusion of cohort studies and case-control studies, whose potential bias may overstate results. Conclusion Perioperative blood transfusion has a significant correlation with the reduction of recurrence-free survival, tumor-specific survival and overall survival. However, there is still a need to design well-designed, prospective, randomized, controlled trials to provide high-quality evidence to further demonstrate the issue.