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Meta-Analysis
. 2006 Jan 25;2006(1):CD005033.
doi: 10.1002/14651858.CD005033.pub2.

Perioperative blood transfusions for the recurrence of colorectal cancer

A Amato  1 , M Pescatori
Affiliations
Meta-Analysis

Perioperative blood transfusions for the recurrence of colorectal cancer

A Amato et al. Cochrane Database Syst Rev. .

Abstract

Background: The improvement of renal allograft survival by pre-transplantation transfusions alerted the medical community to the potential detrimental effect of transfusions in patients being treated for cancer.

Objectives: The present meta-analysis aims to evaluate the role of perioperative blood transfusions (PBT) on colorectal cancer recurrence. This is accomplished by validating the results of a previously published meta-analysis (Amato 1998); and by updating it to December 2004.

Search strategy: Published papers were retrieved using Medline, EMBASE, the Cochrane Library, controlled trials web-based registries, or the CCG Trial Database. The search strategy used was: {colon OR rectal OR colorectal} WITH {cancer OR tumor OR neoplasm} AND transfusion. The tendency not to publish negative trials was balanced by inspecting the proceedings of international congresses.

Selection criteria: Patients undergoing curative resection of colorectal cancer (classified either as Dukes stages A-C, Astler-Coller stages A-C2, or TNM stages T1-3a/N0-1/M0) were included if they had received any amount of blood products within one month of surgery. Excluded were patients with distant metastases at surgery, and studies with short follow-up or with no data.

Data collection and analysis: A specific form was developed for data collection. Data extraction was cross-checked, using the most recent publication in case of repetitive ones. Papers' quality was ranked using the method by Evans and Pollock. Odds ratios (OR, with 95% confidence intervals) were computed for each study, and pooled estimates were generated by RevMan (version 4.2). When available, data were stratified for risk factors of cancer recurrence.

Main results: The findings of the 1998 meta-analysis were confirmed, with small variations in some estimates. Updating it through December 2004 led to the identification of 237 references. Two-hundred and one of them were excluded because they analyzed survival (n=22), were repetitive (n=26), letters/reviews (n=66) or had no data (n=87). Thirty-six studies on 12,127 patients were included: 23 showed a detrimental effect of PBT; 22 used also multivariable analyses, and 14 found PBT to be an independent prognostic factor. Pooled estimates of PBT effect on colorectal cancer recurrence yielded overall OR of 1.42 (95% CI, 1.20 to 1.67) against transfused patients in randomized controlled studies. Stratified meta-analyses confirmed these findings, also when stratifying patients by site and stage of disease. The PBT effect was observed regardless of timing, type, and in a dose-related fashion, although heterogeneity was detected. Data on surgical techniques was not available for further analysis.

Authors' conclusions: This updated meta-analysis confirms the previous findings. All analyses support the hypothesis that PBT have a detrimental effect on the recurrence of curable colorectal cancers. However, since heterogeneity was detected and conclusions on the effect of surgical technique could not be drawn, a causal relationship cannot still be claimed. Carefully restricted indications for PBT seems necessary.

PubMed Disclaimer

Conflict of interest statement

I certify that I have no affiliations with or involvement in any organisation or entity with a direct financial interest in the subject matter of the review (e.g. employment, consultancy, stock ownership, honoraria, expert testimony).

Figures

1
1
Funnel plot of comparison: 1 Studies on Recurrence, outcome: 1.1 All Studies.
2
2
Forest plot of comparison: 1 Studies on Recurrence, outcome: 1.1 All Studies.
3
3
Forest plot of comparison: 1 Studies on Recurrence, outcome: 1.3 Retrospective Studies.
4
4
Forest plot of comparison: 1 Studies on Recurrence, outcome: 1.4 Multivariate Analysis.
5
5
Forest plot of comparison: 1 Studies on Recurrence, outcome: 1.7 Top 25% Quality.
6
6
Forest plot of comparison: 1 Studies on Recurrence, outcome: 1.2 Prospective Studies and Randomized Controlled Studies.
7
7
Forest plot of comparison: 1 Studies on Recurrence, outcome: 1.8 Colon Cancer.
8
8
Forest plot of comparison: 1 Studies on Recurrence, outcome: 1.10 Dukes A‐B.
9
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Forest plot of comparison: 1 Studies on Recurrence, outcome: 1.11 Dukes C.
10
10
Forest plot of comparison: 1 Studies on Recurrence, outcome: 1.12 Pre‐operative Transfusions.
11
11
Forest plot of comparison: 1 Studies on Recurrence, outcome: 1.13 Intra‐operative Transfusions.
12
12
Forest plot of comparison: 1 Studies on Recurrence, outcome: 1.14 Post‐operative Transfusions.
13
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Forest plot of comparison: 1 Studies on Recurrence, outcome: 1.15 Red Blood Cells.
14
14
Forest plot of comparison: 1 Studies on Recurrence, outcome: 1.16 Whole Blood.
15
15
Forest plot of comparison: 1 Studies on Recurrence, outcome: 1.17 1‐2 Transfused Units.
16
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Forest plot of comparison: 1 Studies on Recurrence, outcome: 1.18 3‐4 Transfused Units.
17
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Forest plot of comparison: 1 Studies on Recurrence, outcome: 1.19 >=5 Transfused Units.
1.1
1.1. Analysis
Comparison 1 Studies on Recurrence, Outcome 1 All Studies.
1.2
1.2. Analysis
Comparison 1 Studies on Recurrence, Outcome 2 Prospective Studies.
1.3
1.3. Analysis
Comparison 1 Studies on Recurrence, Outcome 3 Retrospective Studies.
1.4
1.4. Analysis
Comparison 1 Studies on Recurrence, Outcome 4 Multivariate Analysis.
1.5
1.5. Analysis
Comparison 1 Studies on Recurrence, Outcome 5 RCTs/PCs.
1.6
1.6. Analysis
Comparison 1 Studies on Recurrence, Outcome 6 Specific RCTs.
1.7
1.7. Analysis
Comparison 1 Studies on Recurrence, Outcome 7 Top 25% Quality.
1.8
1.8. Analysis
Comparison 1 Studies on Recurrence, Outcome 8 Colon Cancer.
1.9
1.9. Analysis
Comparison 1 Studies on Recurrence, Outcome 9 Rectal Cancer.
1.10
1.10. Analysis
Comparison 1 Studies on Recurrence, Outcome 10 Dukes A‐B.
1.11
1.11. Analysis
Comparison 1 Studies on Recurrence, Outcome 11 Dukes C.
1.12
1.12. Analysis
Comparison 1 Studies on Recurrence, Outcome 12 Pre‐operative Transfusions.
1.13
1.13. Analysis
Comparison 1 Studies on Recurrence, Outcome 13 Intra‐operative Transfusions.
1.14
1.14. Analysis
Comparison 1 Studies on Recurrence, Outcome 14 Post‐operative Transfusions.
1.15
1.15. Analysis
Comparison 1 Studies on Recurrence, Outcome 15 Red Blood Cells.
1.16
1.16. Analysis
Comparison 1 Studies on Recurrence, Outcome 16 Whole Blood.
1.17
1.17. Analysis
Comparison 1 Studies on Recurrence, Outcome 17 1‐2 Transfused Units.
1.18
1.18. Analysis
Comparison 1 Studies on Recurrence, Outcome 18 3‐4 Transfused Units.
1.19
1.19. Analysis
Comparison 1 Studies on Recurrence, Outcome 19 >=5 Transfused Units.
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD005033

References

References to studies included in this review

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