Blood transfusions may adversely affect survival outcomes of patients with lung cancer: a systematic review and meta-analysis

Department of Pediatrics, University of South Florida Morsani College of Medicine, Tampa, FL, USA. Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. Department of Physical Medicine and Rehabilitation, Geisinger Health System, Danville, PA, USA. Department of Internal Medicine, University of Hawaii, Honolulu, HI, USA. Department of Medicine, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA, USA. Department of Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA. Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Republic of Korea. Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA.

Translational lung cancer research. 2021;10(4):1700-1710
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BACKGROUND Despite common use in clinical practice, the impact of blood transfusions on prognosis among patients with lung cancer remains unclear. The purpose of the current study is to perform an updated systematic review and meta-analysis to evaluate the influence of blood transfusions on survival outcomes of lung cancer patients. METHODS We searched PubMed, Embase, Cochrane Library, and Ovid MEDLINE for publications illustrating the association between blood transfusions and prognosis among people with lung cancer from inception to November 2019. Overall survival (OS) and disease-free survival (DFS) were the outcomes of interest. Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were computed using the random-effects model. Study heterogeneity was evaluated with the I(2) test. Publication bias was explored via funnel plot and trim-and-fill analyses. RESULTS We included 23 cohort studies with 12,175 patients (3,027 cases and 9,148 controls) for meta-analysis. Among these records, 22 studies investigated the effect of perioperative transfusions, while one examined that of transfusions during chemotherapy. Two studies suggested the possible dose-dependent effect in accordance with the number of transfused units. In pooled analyses, blood transfusions deleteriously influenced both OS (HR=1.35, 95% CI: 1.14-1.61, P<0.001, I(2)=0%) and DFS (HR=1.46, 95% CI: 1.15-1.86, P=0.001, I(2)=0%) of people with lung cancer. No evidence of significant publication bias was detected in funnel plot and trim-and-fill analyses (OS: HR=1.26, 95% CI: 1.07-1.49, P=0.006; DFS: HR=1.35, 95% CI: 1.08-1.69, P=0.008). CONCLUSIONS Blood transfusions were associated with decreased survival of patients with lung cancer.
Study details
Study Design : Systematic Review
Language : eng
Credits : Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine