China Academy of Chinese Medical Sciences, Beijing, China.
Integr Cancer Ther. 2021 Jan-Dec;20:15347354211058169. doi: 10.1177/15347354211058169.
To access the comparative effectiveness and safety of different oral Chinese patent medicine (OCPM) versus oxaliplatin-based chemotherapy regimen (C) alone for colorectal cancer (CRC) through network meta-analysis (NMA).
Several electronic databases were searched for randomized controlled trials (RCTs) concentrated on the use of OCPM to treat CRC with C from the inception of the databases to January 10, 2021. We performed frequentist NMA and indirect comparison to compare study outcomes from the included RCTs. The risk of bias of each study was assessed using the Cochrane risk of bias tool. Confidence in evidence was assessed using Confidence in Network Meta-Analysis (CINeMA).
A total of 31 RCTs with 1985 participants comparing 10 OCPM, namely, Antike (ATK), Shenyi (SY), Huachansu (HCS), Boerning (BEN), Xiaoaiping (XAP), Jinlong (JL), Compound matrine (CC), Pingxiao (PX), Xihuang pill (XHW), Kangaiping (KAP) were identified. The methodological quality of included RCTs was not very high. The results of the NMA showed that the comparisons were all indirect. Among diverse OCPM, ATK + C had the highest objective response rate (ORR) with a -score of .63 with risk ratio (RR) of 1.37 (95% CI 1.12-1.66); with a RR of 1.96 (1.26-3.05), SY + C had the highest performance status with a -score of .73; KAP + C had the lowest nausea and vomiting with a -score of .91 and with a RR of 0.29 (0.10-0.79); and JL + C had lowest leukopenia with a -score of .95 with a RR of 0.47 (0.31-0.72). The results of pairwise comparison suggested no difference in outcomes among 10 kinds of OCPM + C. The comparison-adjusted funnel plots suggested that there might not be small-study effects for outcomes. According to the CINeMa approach, the confidence rating of this NMA ranged from "very low" to "low" for various comparisons.
Based on the NMA, ATK + C, SY + C, KAP + C and JL + C were associated with more preferable and options for CRC patients when referring to ORR, performance status, nausea and vomiting, and leukopenia, respectively. However, owing to the limitations of this research, the above conclusions require further verification by more high-quality RCTs.
CRD42020160658.
通过网络荟萃分析（NMA）评估不同的中药复方（OCPM）与奥沙利铂为基础的化疗方案（C）单独治疗结直肠癌（CRC）的比较疗效和安全性。
从数据库建立到 2021 年 1 月 10 日，我们在几个电子数据库中检索了集中使用 OCPM 治疗 CRC 并与 C 联合使用的随机对照试验（RCT）。我们采用了频率论 NMA 和间接比较来比较纳入 RCT 的研究结果。使用 Cochrane 偏倚风险工具评估每个研究的偏倚风险。使用置信网络荟萃分析（CINeMA）评估证据的可信度。
共纳入 31 项 RCT，涉及 1985 名参与者，比较了 10 种 OCPM，分别为安替可（ATK）、参一胶囊（SY）、华蟾素（HCS）、博宁（BEN）、消癌平（XAP）、金龙胶囊（JL）、复方苦参（CC）、平消片（PX）、西黄丸（XHW）、康艾扶正片（KAP）。纳入 RCT 的方法学质量不是很高。NMA 的结果表明，所有比较均为间接比较。在不同的 OCPM 中，ATK+C 的客观缓解率（ORR）最高，-评分为.63，风险比（RR）为 1.37（95%置信区间 1.12-1.66）；SY+C 的表现状态最好，-评分为.73；KAP+C 的恶心和呕吐发生率最低，-评分为.91，RR 为 0.29（0.10-0.79）；JL+C 的白细胞减少发生率最低，-评分为.95，RR 为 0.47（0.31-0.72）。两两比较的结果表明，10 种 OCPM+C 之间的疗效无差异。校正后的比较调整漏斗图表明，对于各种结局，可能没有小样本效应。根据 CINeMa 方法，对于各种比较，该 NMA 的置信度评分范围从“非常低”到“低”。
基于 NMA，ATK+C、SY+C、KAP+C 和 JL+C 分别与 CRC 患者的 ORR、表现状态、恶心和呕吐以及白细胞减少相关，具有更好的选择和应用。然而，由于本研究的局限性，上述结论需要更多高质量 RCT 的进一步验证。
PROSPERO 注册号：CRD42020160658。
