Abstract
ObjectiveTo assess the comparative efficacy and safety of combination treatment with Compound Kushen Injection (CKI) and transarterial chemoembolization (TACE) in patients with advanced hepatocellular carcinoma (HCC) through a systematic review and network meta-analysis and to identify the best conditions for using CKI.Materials and MethodsWe performed a network meta-analysis based on randomized controlled trials. We searched databases for studies published by August 2017. The prespecified primary efficacy outcome was treatment response, while the secondary efficacy outcomes were KPS score, Child-Pugh score, overall survival rate, clinical symptoms, and improvements in immune function and liver function; we performed subgroup analyses and meta-regressions according to the different TACE arms, CKI dosage, composition of CKI, embolizing agents and treatment duration. The safety outcomes were side effects. We conducted pairwise meta-analyses using a random-effects model and then performed random-effects network meta-analyses.ResultsA total of 44 trials, involving 3778 patients and 22 intervention arms, were eligible. TACE+CKI could significantly increase treatment response (1.85, 1.56 to 2.20) and improve therapeutic efficacy based on the secondary outcomes. Significant efficacy was observed in most subgroups. Network meta-analysis revealed that CKI was very suitable for combination treatment when the TACE arm included 5-fluorouracil+epirubicin+hydroxycamptothecin, pirarubicin+hydroxycamptothecin and 5-fluorouracil+pirarubicin+mitomycin+hydroxycamptothecin. The study is registered with PROSPERO (CRD42017073181).ConclusionsRegarding efficacy, TACE+CKI offers clear advantages for patients with advanced HCC. Moreover, patients should be encouraged to accept CKI, especially when the chemotherapeutic drugs in TACE have high levels of adriamycins (epirubicin and pirarubicin) and hydroxycamptothecin.
Highlights
Liver cancer is one of the most common cancers with dismal outcomes including cancer-related death [1,2]
transarterial chemoembolization (TACE)+Compound Kushen Injection (CKI) could significantly increase treatment response (1.85, 1.56 to 2.20) and improve therapeutic efficacy based on the secondary outcomes
Network meta-analysis revealed that CKI was very suitable for combination treatment when the TACE arm included 5-fluorour acil+epirubicin+hydroxycamptothecin, pirarubicin+hydroxycamptothecin and 5-fluo rouracil+pirarubicin+mitomycin+hydroxycamptothecin
Summary
Liver cancer (primarily hepatocellular carcinoma, HCC) is one of the most common cancers with dismal outcomes including cancer-related death [1,2]. HCC is a common disease and accounts for 54% of the total number of cancer patients worldwide, with more than 600,000 related deaths estimated each year [1]. HCC is the fifthmost common malignancy and the second leading cause of cancer-related death worldwide; the 5-year survival rate of HCC is 15–17% [3]; the incidence rates of liver cancer have continued to increase rapidly by approximately 3%. A small proportion of patients with earlystage HCC can benefit from radical treatment options, such as surgical resection and orthotopic liver transplantation. Surgical resection is not the first treatment choice for HCC patients with large lesions or poor liver function
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