Wang Q, Wang Q, Wang S F, Jiao L J, Zhang R X, Zhong Y, Zhang J, Xu L
Department of Oncology, Yueyang Hospital of Integrated Traditional Chinese Medicine and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine.
Department of Oncology, Shanghai Hospital of Integrated Traditional Chinese Medicine and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine.
Curr Oncol. 2017 Aug;24(4):e269-e276. doi: 10.3747/co.24.3561. Epub 2017 Aug 31.
The concept of maintenance therapy in cancer treatment is currently under debate because of modest survival benefits, added toxicity, economic considerations, and quality-of-life concerns. Traditional Chinese Medicine (tcm) is widely used in China for cancer patients, offering the advantages of low toxicity and enhancement of quality of life. However, no systematic reviews or meta-analyses have assessed the role of tcm as maintenance treatment for non-small-cell lung carcinoma.
We searched the Chinese Biomedical Literature Database, the China National Knowledge Infrastructure, PubMed, embase, and the Cochrane Library databases for all eligible studies. The endpoints were overall survival (os), progression-free survival (pfs), the 1-year and 2-year survival rates, and performance status. Our meta-analysis used a fixed-effects model and a random-effects model for heterogeneity in the Stata software application (version 11.0: StataCorp LP, College Station, TX, U.S.A.), with the results expressed as hazard ratios (hrs) or risk ratios (rrs), with their corresponding 95% confidence intervals (95% cis).
Sixteen randomized studies representing 1150 patients met the inclusion criteria. Compared with best supportive care, observation, or placebo, tcm as maintenance treatment was associated with a significant increase in os (hr: 0.49; 95% ci: 0.35 to 0.68; < 0.001), pfs (hr: 0.66; 95% ci: 0.51 to 0.84; = 0.001), and 2-year survival rate (rr: 0.63; 95% ci: 0.44 to 0.92, = 0.017), and a significant improvement in performance status (rr: 0.68; 95% ci: 0.61 to 0.75; < 0.001).
For patients who show non-progression-including stable disease, partial response, or complete response-after first-line chemotherapy, including those with poor quality of life, oral Chinese herbal medicine can be considered an efficient and safe maintenance therapy strategy.
由于生存获益有限、毒性增加、经济因素以及生活质量问题，癌症治疗中的维持治疗概念目前仍存在争议。中药在中国被广泛应用于癌症患者，具有低毒性和提高生活质量的优势。然而，尚无系统评价或荟萃分析评估中药作为非小细胞肺癌维持治疗的作用。
我们检索了中国生物医学文献数据库、中国知网、PubMed、Embase和Cochrane图书馆数据库，以查找所有符合条件的研究。终点指标为总生存期（OS）、无进展生存期（PFS）、1年和2年生存率以及体能状态。我们的荟萃分析在Stata软件应用程序（版本11.0：美国德克萨斯州大学站StataCorp LP公司）中使用固定效应模型和随机效应模型处理异质性，结果以风险比（HRs）或比值比（RRs）及其相应的95%置信区间（95% CIs）表示。
16项随机研究共1150例患者符合纳入标准。与最佳支持治疗、观察或安慰剂相比，中药作为维持治疗可显著提高OS（HR：0.49；95% CI：0.35至0.68；P<0.001）、PFS（HR：0.66；95% CI：0.51至0.84；P = 0.001）和2年生存率（RR：0.63；95% CI：0.44至0.92，P = 0.017），并显著改善体能状态（RR：0.68；95% CI：0.61至0.75；P<0.001）。
对于一线化疗后病情无进展（包括疾病稳定、部分缓解或完全缓解）的患者，包括生活质量较差的患者，口服中药可被视为一种有效且安全的维持治疗策略。
