The Second Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510405, P.R. China; State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510120, PR China; Department of Oncology, Clinical and Basic Research Team of TCM Prevention and Treatment of NSCLC, Guangdong-HongKong-Macau Joint Lab on Chinese Medicine and Immune Disease Research, Guangdong Provincial Key Laboratory of Clinical Research on Traditional Chinese Medicine Syndrome, Guangdong Provincial Hospital of Chinese Medicine, The Second Clinical Medical College of Guangzhou University of Chinese Medicine; Guangzhou, Guangdong 510120, PR China.
Artemisinin Research Center, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510405, PR China.
Phytomedicine. 2022 Jul 20;102:154141. doi: 10.1016/j.phymed.2022.154141. Epub 2022 May 13.
In China, Brucea javanica oil emulsion injection (BJOEI) has been used as adjuvant therapy to treat cancer for many years. Many systematic reviews (SRs) or meta-analyses (MAs) were published to evaluate its efficacy and safety. Nevertheless, uneven quality made it difficult to reach a consensus and there has been no specific review to integrate the evidence of BJOEI for cancer at present. Therefore, a comprehensive evidence map is needed to guide clinicians.
We, for the first time, conducted an overview to assess the SRs/MAs of BJOEI, and provided a comprehensive evidence map to guide clinicians. Besides, this study provided a promising direction for future research to promote the generation of advanced evidence.
An overview of SRs or MAs.
The pre-defined search strategies were applied to 8 databases. Suitable SRs/MAs were included according to the inclusion and exclusion criteria. Methodological quality, reporting quality, and risk of bias were assessed. An evidence map was conducted to show the situation of clinical evidence.
27 SRs/MAs in 7 cancer types were included in this overview. The main problems of SRs/MAs were concentrated on the following aspects: without registration or protocol, lacking gray literature retrieval and a list of excluded studies, incomplete description in the literature retrieval strategy or the methods of merging results, the bias of each synthetic result, less exploration in heterogeneity or publication bias, deficiencies in assessing evidence quality and less description in conflict, funding or access to relevant information. Based on the rules of GRADE, the evidence quality of 154 items in 27 SRs/MAs was defined as moderate quality (103 items), low-quality (44 items), and very low-quality (7 items). Especially, risk of bias (154 items), imprecision (27 items), inconsistency (20 items), and publication bias (9 items) were the main downgrading factors.
BJOEI may be a promising adjuvant therapy for treating cancer, especially in the digestive system. However, high-quality SRs/MAs are expected to be carried out to improve the reliability of the above conclusion in the future.
在中国，鸦胆子油乳注射液（BJOEI）多年来一直被用作癌症的辅助治疗药物。许多系统评价（SRs）或荟萃分析（MAs）发表以评估其疗效和安全性。然而，由于质量参差不齐，难以达成共识，目前尚无专门的综述来综合 BJOEI 治疗癌症的证据。因此，需要一份综合的证据图来指导临床医生。
我们首次进行了综述，评估了 BJOEI 的 SRs/MAs，并提供了一份综合证据图来指导临床医生。此外，本研究为未来的研究提供了一个有前途的方向，以促进高级证据的产生。
SRs 或 MAs 的概述。
采用预定义的搜索策略检索 8 个数据库。根据纳入和排除标准纳入合适的 SRs/MAs。评估方法学质量、报告质量和偏倚风险。进行证据图以显示临床证据的情况。
本综述纳入了 7 种癌症类型的 27 项 SRs/MAs。SRs/MAs 的主要问题集中在以下几个方面：未注册或未制定方案，缺乏灰色文献检索和排除研究清单，文献检索策略或合并结果的方法不完整，每个综合结果的偏倚，对异质性或发表偏倚的探索较少，评估证据质量的不足以及对冲突、资助或获取相关信息的描述较少。根据 GRADE 规则，27 项 SRs/MAs 中的 154 项的证据质量被定义为中等质量（103 项）、低质量（44 项）和极低质量（7 项）。特别是，偏倚（154 项）、不精确（27 项）、不一致性（20 项）和发表偏倚（9 项）是主要的降级因素。
BJOEI 可能是治疗癌症的一种有前途的辅助治疗方法，特别是在消化系统中。然而，预计未来将进行高质量的 SRs/MAs，以提高上述结论的可靠性。
