The Therapeutic Principle of Combined Strengthening Qi and Eliminating Pathogens in Treating Middle-Advanced Primary Liver Cancer: A Systematic Review and Meta-Analysis.

Yingqi She,Yuyao Liu,Qiaobo Ye,Ailing Wei,Kaihua Qin,Mingquan Wu,Yu Hu,Xin Yang,Zhen Ye,Qinfeng Huang,Cuihan Zhang

doi:10.3389/fphar.2021.714287

Abstract

Background: The combination of strengthening Qi and eliminating pathogens is an available therapeutic principle in traditional Chinese medicine (TCM) for primary liver cancer (PLC) at middle-advanced stage. However, there is a lack of reasonable evidence to support the proper application of this therapeutic principle. This meta-analysis aims to evaluate the efficacy and safety of Chinese medicinal formulas (CMFs), including two subgroup analyses of the principle of strengthening Qi and eliminating pathogens. Method: Clinical trials were obtained through searching of EMBASE, Web of Science, PubMed, Cochrane Library, Chinese National Knowledge Infrastructure, Wanfang Database, Chinese Scientific Journal Database, Chinese Biomedical Literature Database, and two clinical trial registries. The randomized controlled trials with the combination of CMFs and transcatheter arterial chemoembolization (TACE) in the experiment group were acceptable, in contrast to the TACE alone in the control group. The statistics analysis was performed on Review Manager 5.4. Results: A total of eligible 24 trials were accessed in this work. Overall, CMFs could improve the survival duration of 6 months, 1 year, and 2 years, Karnofsky Performance Status, tumor objective response rate (ORR), AFP, and symptom. In the subgroup analysis, trials complying with the principle of single strengthening Qi did not show any significant difference in increasing tumor ORR. Meanwhile, the principle of combined strengthening Qi and eliminating pathogens was uncertain in improving symptoms and 1-year and 2-year survival time. In addition, the outcome indexes of ALT and AST were heterogeneous. In last, the total occurrence of adverse events could not be reduced via using CMFs. Patients treated with CMFs exhibited liver injury, fever, and white blood cell decline, with mild events occurring more frequently and severe events occurring less. Conclusion: CMFs are an effective treatment method to cure PLC at the middle-advanced stage. Adopting the principle of single strengthening Qi presents better efficacy in the long term by prolonging the survival duration. Following the principle of combined strengthening Qi and eliminating pathogens could be more beneficial to patients in short term by lessening the tumor size. CMFs have the advantage of reducing certain serious adverse events.

Highlights

Primary liver cancer (PLC) is one of the common digestive system neoplasms, including most of the hepatocellular carcinoma (HCC), a small part of cholangiocarcinoma (CCC), and combined hepatocholangiocarcinoma (HCCICC)
The electronic search was from their inception until December 18, 2020, which was performed in the Chinese National Knowledge Infrastructure (CNKI), the Wanfang Database, the Chinese Scientific Journal Database (VIP), the Chinese Biomedical Literature Database (CBM), Excerpta Medica Database (EMBASE), Web of Science, PubMed, and Cochrane Library
We were concerned about the incidence of various adverse events of drastic medicinals, due to the few included studies, the current results only showed that drastic medicinals had to alleviate effects on nausea and vomiting, digestive symptoms, and bone marrow suppression

Summary

Introduction

Primary liver cancer (PLC) is one of the common digestive system neoplasms, including most of the hepatocellular carcinoma (HCC), a small part of cholangiocarcinoma (CCC), and combined hepatocholangiocarcinoma (HCCICC). In all the regions and nations, China could not be ignored as it has the largest population of HCC patients (Zhu et al, 2016) Both male and female morbidity and mortality dropped from 2000 to 2015 in China, the PLC still ranked fourth in new cases and second place in cancer mortality (Zhang et al, 2020). The combination of strengthening Qi and eliminating pathogens is an available therapeutic principle in traditional Chinese medicine (TCM) for primary liver cancer (PLC) at middle-advanced stage. There is a lack of reasonable evidence to support the proper application of this therapeutic principle This meta-analysis aims to evaluate the efficacy and safety of Chinese medicinal formulas (CMFs), including two subgroup analyses of the principle of strengthening Qi and eliminating pathogens

Methods

Results

Discussion

Conclusion