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Allogeneic blood transfusion and the prognosis of gastric cancer patients: systematic review and meta-analysis.

AbstractBACKGROUND:
Perioperative allogeneic blood transfusion (ABT) may be a deleterious predictor on the prognosis of gastric cancer (GC) for subjects who had undergone curative surgeries. In this article we proposed to figure out the effect of ABT with a systematic review and meta-analysis.
METHODS:
Relevant articles were identified by searching Pubmed and Embase to March 2014. A random-effects model or fixed-effects model was used to calculate pooled odds ratios (ORs). Sensitivity analysis, meta-regression, stratified analysis, dose-response meta-analysis were conducted, and publication bias tested.
RESULTS:
Eighteen studies (9120 GC patients) were included, of which 36.3% received transfusions. ABT was associated with increased all-cause mortality (OR, 2.17; 95% confidence interval [CI], 1.72-2.74; p<0.001; I2=75%). Sensitivity analysis showed significant changes in ORs while meta-regression had little influence on ORs. Galbraith plot revealed the OR reduced to 2.10 (95% CI, 1.86-2.37; p<0.001) with tau2 reduced to 0.00 and I2 reduced to 0%. RESULTS of stratified analysis were robust and consistent. Dose-response meta-analysis revealed that all-cause mortality was significantly lower in patients transfused with ≤800 mL of blood than those transfused with >800 mL (OR, 0.58; 95% CI, 0.37-0.92; p=0.02; I2=54%). ABT was also associated with increased cancer-related mortality (OR, 2.57, p=0.011) and recurrence (OR, 1.52, p=0.017).
CONCLUSIONS:
In GC patients undergoing curative surgeries, ABTs are associated with a worse prognosis, including all-cause mortality, cancer-related mortality and recurrence. Patient blood management should be investigated further to minimize use of ABT.
AuthorsChang Sun, Yi Wang, Hou Shan Yao, Zhi Qian Hu
JournalInternational journal of surgery (London, England) (Int J Surg) Vol. 13 Pg. 102-110 (Jan 2015) ISSN: 1743-9159 [Electronic] England
PMID25486261 (Publication Type: Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't, Review, Systematic Review)
CopyrightCopyright © 2014 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.
Topics
  • Blood Transfusion (mortality)
  • Cause of Death
  • Humans
  • Neoplasm Recurrence, Local
  • Odds Ratio
  • Prognosis
  • Risk Factors
  • Stomach Neoplasms (mortality, surgery)
  • Transfusion Reaction
  • Treatment Outcome

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