Wu Xinyin, Chung Vincent C H, Lu Ping, Poon Simon K, Hui Edwin P, Lau Alexander Y L, Balneaves Lynda G, Wong Samuel Y S, Wu Justin C Y
From the Hong Kong Institute of Integrative Medicine (XW, VCHC, LP, SYSW), Jockey Club School of Public Health and Primary Care (XW, VCHC, EPH, AYLL, SYSW, JCYW), Comprehensive Cancer Trials Unit (EPH), and Department of Medicine and Therapeutics (AYLL, JCYW), The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong; School of Information Technologies, The University of Sydney, Sydney, Australia (SKP); and Centre for Integrative Medicine, University of Toronto, Toronto, ON, Canada (LGB).
Medicine (Baltimore). 2016 Jan;95(1):e2410. doi: 10.1097/MD.0000000000002410.
For patients with nonsmall cell lung cancer (NSCLC) receiving chemotherapy, current clinical evidence has indicated add-on benefit of Chinese herbal medicine (CHM) in improving quality of life (QoL). However, the relative performance among different CHM is unknown. The aim of this overview of systematic reviews (SRs) and network meta-analyses (NMA) is to evaluate the comparative effectiveness of different CHM. Seven electronic databases including both international databases and Chinese databases were searched. SRs focus on randomized controlled trials (RCTs) with comparison of CHM plus chemotherapy against chemotherapy alone on QoL among NSCLC patients were considered eligible. Data from RCTs were extracted for random effect pairwise meta-analyses. Pooled relative risk (RR) with 95% confidence interval (CI) was used to quantify the impact of CHM on QoL. NMA was used to explore the most effective CHM for improving QoL when used with chemotherapy. From 14 SRs, 61 RCTs (n = 4247) assessing 11 different CHM were included. Result from pairwise meta-analyses showed 6 CHM (Kang-lai-te injection, Shei-qi-fu-zheng injection, Compound ku-shen injection, Kang-ai injection, Zi-jin-long tablet, and Shen-fu injection) has significant beneficial effect on QoL among NSCLC patients when used with chemotherapy, even after adjustment for publication bias. Pooled RR varied from 1.38 (95% CI: 1.11-1.72, I2 = 0.0%, Kang-lai-te injection) to 3.36 (95% CI: 1.30-8.66, I2 = 0.0%, Zi-jin-long tablet). One trial comparing Hai-shen-su (a protein extract from Tegillarca granosa L.) plus chemotherapy with chemotherapy also demonstrated beneficial effect of combined treatment (RR = 3.13, 95% CI: 1.41-6.98). Results from NMA showed no differences on the comparative effectiveness among CHM, but Hai-shen-su plus chemotherapy has the highest probability (62.3%) of being the best option for improving QoL. Use of CHM on top of chemotherapy can significantly improve QoL in NSCLC patients. Although Hai-shen-su showed the highest probability of being the best add-on to chemotherapy, the effectiveness of all 11 CHM reviewed appeared to be similar. In the future, rigorous placebo controlled trials with proper blinding are needed to confirm the effectiveness of CHM.
对于接受化疗的非小细胞肺癌（NSCLC）患者，目前的临床证据表明，中药（CHM）在改善生活质量（QoL）方面具有附加益处。然而，不同中药之间的相对疗效尚不清楚。本系统评价（SRs）和网状Meta分析（NMA）概述的目的是评估不同中药的比较疗效。检索了包括国际数据库和中文数据库在内的七个电子数据库。纳入的SRs聚焦于随机对照试验（RCTs），这些试验比较了NSCLC患者中中药联合化疗与单纯化疗对生活质量的影响。从RCTs中提取数据进行随机效应成对Meta分析。采用合并相对风险（RR）及95%置信区间（CI）来量化中药对生活质量的影响。NMA用于探索与化疗联合使用时改善生活质量最有效的中药。从14项SRs中，纳入了评估11种不同中药的61项RCTs（n = 4247）。成对Meta分析结果显示，6种中药（康莱特注射液、参芪扶正注射液、复方苦参注射液、康艾注射液、紫金龙片和参附注射液）与化疗联合使用时，对NSCLC患者的生活质量有显著有益影响，即使在调整发表偏倚后也是如此。合并RR从1.38（95%CI：1.11 - 1.72，I2 = 0.0%，康莱特注射液）到3.36（95%CI：1.30 - 8.66，I2 = 0.0%，紫金龙片）不等。一项比较海生素（一种泥蚶蛋白提取物）联合化疗与单纯化疗的试验也证明了联合治疗的有益效果（RR = 3.13，95%CI：1.41 - 6.98）。NMA结果显示，中药之间的比较疗效无差异，但海生素联合化疗成为改善生活质量最佳选择的概率最高（62.3%）。在化疗基础上加用中药可显著改善NSCLC患者的生活质量。尽管海生素显示出作为化疗最佳附加药物的概率最高，但所审查的所有11种中药的疗效似乎相似。未来，需要进行严格的安慰剂对照试验并进行适当的盲法处理，以证实中药的有效性。
