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Meta-Analysis
. 2015 Jun 16;10(6):e0130122.
doi: 10.1371/journal.pone.0130122. eCollection 2015.

Perioperative Blood Transfusion Promotes Worse Outcomes of Bladder Cancer after Radical Cystectomy: A Systematic Review and Meta-Analysis

You-Lin Wang  1 , Bo Jiang  1 , Fu-Fen Yin  2 , Hao-Qing Shi  3 , Xiao-Dong Xu  3 , Shuai-Shuai Zheng  1 , Shuai Wu  1 , Si-Chuan Hou  4
Affiliations
Meta-Analysis

Perioperative Blood Transfusion Promotes Worse Outcomes of Bladder Cancer after Radical Cystectomy: A Systematic Review and Meta-Analysis

You-Lin Wang et al. PLoS One. .

Abstract

Background: Multiple studies have investigated the effect of perioperative blood transfusion (PBT) for patients with radical cystectomy (RC), but the results have been inconsistent. We conducted a systematic review and meta-analysis to investigate the relationship between PBT and the clinical outcomes of RC patients.

Methods: We searched MEDLINE, EMBASE, the Cochrane library and BIOSIS previews to identify relevant literature for studies that focused on the relationship of PBT and outcomes of patients undergoing RC. A fixed or random effects model was used in this meta-analysis to calculate the pooled hazard ratio (HR) with 95% confidence intervals (CIs).

Results: A total of 7080 patients in 6 studies matched the selection criteria. Aggregation of the data suggested that PBT in patients who underwent RC correlated with increased all-cause mortality, cancer-specific mortality and cancer recurrence. The combined HRs were 1.19 (n = 6 studies, 95% CI: 1.11-1.27, Z = 4.71, P<0.00001), 1.17 (n = 4 studies, 95% CI: 1.06-1.30, Z = 3.06, P = 0.002), 1.14 (n = 3 studies, 95% CI: 1.03-1.27, Z = 2.50, P = 0.01), respectively. The all-cause mortality associated with PBT did not vary by the characteristics of the study, including number of study participants, follow-up period and the median blood transfusion ratio of the study.

Conclusion: Our data showed that PBT significantly increased the risks of all-cause mortality, cancer-specific mortality and cancer recurrence in patients undergoing RC for bladder cancer.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow diagram of study identification process.
Fig 2
Fig 2. Fixed-effect model forest plots of HRs.
(A) All-cause mortality, (B) Cancer-specific mortality, (C) Cancer recurrence. SE: standard error; CI: confidence interval; IV: inverse variance.
Fig 3
Fig 3. Funnel plots for publication bias in studies of PBT in patients with bladder cancer who underwent RC.
(A) All-cause mortality. (B) Cancer-specific mortality. (C) Cancer recurrence.
See this image and copyright information in PMC

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