Abstract
Objective The aim of this network meta-analysis (NMA) was to explore the effectiveness of different traditional Chinese medicine injections (TCMIs) combined with systemic chemotherapy for the treatment of hepatocellular carcinoma (HCC). Methods A comprehensive search for randomized controlled trials (RCTs) was performed with regard to different TCMIs for treating HCC in seven electronic databases up to November 2019. The quality assessment of the included RCTs was conducted according to the Cochrane risk of bias tool. The objective response rate (ORR), clinical benefit rate (CBR), and Karnofsky performance score (KPS) data were extracted. The network meta-analysis used the network package in Stata software to analyse the data and draw a map of the evidence summarizing the direct and indirect comparisons. Results A total of 1697 articles were retrieved through the comprehensive search. Twenty RCTs focusing on Aidi injection, compound Kushen injection, and Kanglaite injection as adjuvant therapies to chemotherapy were included, involving a total of 1418 patients. The NMA statistics showed that all three indicators (ORR, CBR, and KPS) were better in the combined treatment group of TCMIs with chemotherapy than that in the single treatment group of chemotherapy alone. Kanglaite injection tended to be better than the other two in terms of primary outcome, but there was not a significant difference. The combined treatment group had fewer adverse reactions than the single treatment group. Moreover, several articles reported that TCMIs combined with chemotherapy could increase the number of CD3+ and CD4+ T lymphocytes and the ratio of CD4+/CD8+ T lymphocytes. Conclusions TCMIs combined with systemic chemotherapy could be an effective and safe treatment option for patients with HCC. Kanglaite injection showed a tendency to be better than the other two kinds of injections in terms of ORR. Nevertheless, additional results from multicentre trials and high-quality studies will be pivotal for supporting our findings.
Highlights
Hepatocellular carcinoma (HCC) is one of the most common malignant tumours
Traditional Chinese medicine injection (TCMI) is a convenient and effective new method of administering Chinese medicine. e latest Chinese Society of Clinical Oncology (CSCO) guidelines for the diagnosis and treatment of HCC recommend a variety of traditional Chinese medicine injections (TCMIs) for the treatment of late-stage HCC [8], and there have been numerous related randomized controlled trials (RCTs). e majority of the studies focused on TCMIs combined with transcatheter arterial chemoembolization (TACE), while studies on TCMIs combined with systemic chemotherapy were limited, and there was no systematic summary on the latter
One approach to create a systematic summary is a network meta-analysis, which is a technique that combines direct evidence and indirect evidence to compare multiple treatment options. is study aims to make various comparisons between a range of TCMIs combined with systemic chemotherapy and systemic chemotherapy alone in the treatment of patients with HCC by using data from available RCTs in a network meta-analysis
Summary
Hepatocellular carcinoma (HCC) is one of the most common malignant tumours. Its incidence has increased significantly in recent years. e latest statistics show that there are approximately 840,000 new cases of HCC each year worldwide. Diagnostic methods and public awareness of the disease have improved in recent years, most patients have reached the late stage when they are diagnosed; surgery is not an option for these patients, and their prognosis is poor [2, 3]. Chemotherapy has limited efficacy in advanced HCC, it is still a treatment option in patients who cannot. Recent studies have indicated that traditional Chinese medicine (TCM) could play an essential role in the whole course of HCC treatment [7]. Is study aims to make various comparisons between a range of TCMIs combined with systemic chemotherapy and systemic chemotherapy alone in the treatment of patients with HCC by using data from available RCTs in a network meta-analysis One approach to create a systematic summary is a network meta-analysis, which is a technique that combines direct evidence and indirect evidence to compare multiple treatment options. is study aims to make various comparisons between a range of TCMIs combined with systemic chemotherapy and systemic chemotherapy alone in the treatment of patients with HCC by using data from available RCTs in a network meta-analysis
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