Department of Pharmaceutical Analysis, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing 210028, China.
Department of Metabolomics, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing 210028, China.
Food Funct. 2021 Mar 15;12(5):2225-2241. doi: 10.1039/d0fo03341c.
Chemotherapy is applied to treat non-small cell lung cancer (NSCLC), but often limited due to its unstable therapeutic effects and adverse reactions (ADRs). Ginseng and its main ingredients (ginsenosides and polysaccharides) have been clinically used as adjuvants to chemotherapy. However, their efficacies were based on individual trials with relatively small sample sizes, and it is difficult to draw a valid conclusion. In this study, eligible randomized controlled trials (RCTs) were searched in six international and Chinese databases (PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, Chinese VIP Information and Wanfang). The outcomes of the objective response rate (ORR), disease control rate (DCR), ADRs, quality of life (QOL), survival rates and immunity were extracted using standard data extraction forms. The efficacies of ginseng and its ingredients as adjuvants to chemotherapy in NSCLC were investigated and compared by meta-analysis and subgroup meta-analysis, respectively. A total of 28 RCTs including 2503 subjects were enrolled, and most of the eligible studies were of low-to-moderate quality. For the evaluation of ginseng and its ingredients as adjuvants to chemotherapy, the risk ratio (RR) or standardized mean difference (SMD) and 95% confidence intervals (CI) of the ORR, DCR, leucopenia, thrombocytopenia, myelosuppression, hepatotoxicity, nausea and vomiting, diarrhea, CD4+/CD8+ and one- and two-year survival rates, and QOL were 1.35 (1.21,1.50), 1.20 (1.14,1.28), 0.59 (0.50, 0.70), 0.53 (0.37, 0.76), 0.30 (0.17, 0.53), 0.67 (0.52, 0.87), 0.67 (0.53, 0.86), 0.42 (0.19, 0.96), 1.39 (0.63, 2.16), 1.35 (1.13, 1.60), 3.21 (1.51, 6.81) and 1.31 (1.22, 1.41) with significant differences. Subgroup analysis showed that ginseng enhanced nausea and vomiting and QOL, ginsenosides increased ORR, DCR, QOL, leucopenia, thrombocytopenia, myelosuppression, hepatotoxicity, diarrhea, CD4+/CD8+, and one- and two-year survival rates, while polysaccharides improved ORR, DCR, leucopenia, thrombocytopenia, myelosuppression, hepatotoxicity and nausea and vomiting during chemotherapy. In conclusion, ginseng and its ingredients facilitated the therapeutic effects of chemotherapy on NSCLC patients. Ginseng had beneficial effects on alleviating ADRs and enhancing QOL, ginsenosides demonstrated beneficial effects on enhancing therapeutic effects, reducing ADRs, improving immunity, prolonging survival rates and promoting QOL, while polysaccharides showed beneficial effects on promoting therapeutic effects and reducing ADRs.
化疗用于治疗非小细胞肺癌 (NSCLC)，但由于其治疗效果不稳定和不良反应 (ADR) 而常常受到限制。人参及其主要成分（人参皂苷和多糖）已在临床上用作化疗的辅助剂。然而，它们的疗效基于个体试验，样本量相对较小，难以得出有效结论。本研究在六个国际和中文数据库（PubMed、Embase、Cochrane 图书馆、中国国家知识基础设施、中国维普信息和万方）中搜索了合格的随机对照试验 (RCT)。使用标准数据提取表提取客观缓解率 (ORR)、疾病控制率 (DCR)、ADR、生活质量 (QOL)、生存率和免疫的结局。通过荟萃分析和亚组荟萃分析分别研究和比较了人参及其成分作为 NSCLC 化疗辅助剂的疗效。共纳入 28 项 RCT 共 2503 例受试者，大多数合格研究的质量为低到中等。对于评估人参及其成分作为化疗辅助剂的疗效，ORR、DCR、白细胞减少症、血小板减少症、骨髓抑制、肝毒性、恶心和呕吐、腹泻、CD4+/CD8+、一年和两年生存率和 QOL 的风险比 (RR) 或标准化均数差 (SMD) 和 95%置信区间 (CI) 为 1.35 (1.21,1.50)、1.20 (1.14,1.28)、0.59 (0.50, 0.70)、0.53 (0.37, 0.76)、0.30 (0.17, 0.53)、0.67 (0.52, 0.87)、0.67 (0.53, 0.86)、0.42 (0.19, 0.96)、1.39 (0.63, 2.16)、1.35 (1.13, 1.60)、3.21 (1.51, 6.81) 和 1.31 (1.22, 1.41) 有显著差异。亚组分析表明，人参增强了恶心和呕吐以及 QOL，人参皂苷增加了 ORR、DCR、QOL、白细胞减少症、血小板减少症、骨髓抑制、肝毒性、腹泻、CD4+/CD8+、一年和两年生存率，而多糖改善了 ORR、DCR、白细胞减少症、血小板减少症、骨髓抑制、肝毒性和化疗期间的恶心和呕吐。综上所述，人参及其成分有助于提高 NSCLC 患者化疗的疗效。人参对缓解 ADR 和提高 QOL 有有益作用，人参皂苷对增强治疗效果、减少 ADR、提高免疫力、延长生存率和促进 QOL 有有益作用，而多糖对促进治疗效果和减少 ADR 有有益作用。
