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

Annamaria Agnes, Maria Carmen Lirosi, Simona Panunzi, Pietro Santocchi, Roberto Persiani, Domenico D'Ugo

Research output: Contribution to journalReview article

5 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)404-419
Number of pages16
JournalEuropean Journal of Surgical Oncology
Volume44
Issue number4
DOIs
Publication statusPublished - Apr 1 2018

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Blood Transfusion
Stomach Neoplasms
Meta-Analysis
Survival
Disease-Free Survival
Confidence Intervals
Gastrectomy
PubMed
Research Design
Odds Ratio
Databases

Keywords

  • Blood transfusions
  • Confounding
  • Gastrectomy
  • Gastric cancer
  • Meta-analysis
  • Surgery

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

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. / Agnes, Annamaria; Lirosi, Maria Carmen; Panunzi, Simona; Santocchi, Pietro; Persiani, Roberto; D'Ugo, Domenico.

In: European Journal of Surgical Oncology, Vol. 44, No. 4, 01.04.2018, p. 404-419.

Research output: Contribution to journalReview article

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abstract = "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.",
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