title: Allogeneic blood transfusion and the prognosis of gastric cancer patients: systematic review and meta-analysis.
abstract: BACKGROUND
  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.
authors.affiliation: Department of General Surgery, Shanghai Chang Zheng Hospital, Second Military Medical University, 415 Feng Yang Road, Shanghai 200003, China. Electronic address: sunchangdoc@163.com.
authors.forename: Chang
authors.initials: C
authors.lastname: Sun
authors.affiliation: Department of General Surgery, Shanghai Chang Zheng Hospital, Second Military Medical University, 415 Feng Yang Road, Shanghai 200003, China. Electronic address: wyirex@sina.com.
authors.forename: Yi
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of General Surgery, Shanghai Chang Zheng Hospital, Second Military Medical University, 415 Feng Yang Road, Shanghai 200003, China. Electronic address: yao-hs@hotmail.com.
authors.forename: Hou Shan
authors.initials: HS
authors.lastname: Yao
authors.affiliation: Department of General Surgery, Shanghai Chang Zheng Hospital, Second Military Medical University, 415 Feng Yang Road, Shanghai 200003, China. Electronic address: huzq62@163.com.
authors.forename: Zhi Qian
authors.initials: ZQ
authors.lastname: Hu
mesh_terms: D001803:Blood Transfusion / Q000401:mortality*; D002423:Cause of Death; D006801:Humans; D009364:Neoplasm Recurrence, Local; D016017:Odds Ratio; D011379:Prognosis; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000401:mortality* / Q000601:surgery*; D065227:Transfusion Reaction; D016896:Treatment Outcome
keywords: Allogeneic blood transfusion; Curative surgery; Gastric cancer; Prognosis