Xu Yi-Fang, Chen Yun-Ru, Bu Fan-Long, Huang Yu-Bei, Sun Yu-Xin, Li Cheng-Yin, Sellick Jodi, Liu Jian-Ping, Qin Dan-Mei, Liu Zhao-Lan
Department of Oncology, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China.
Centre for Evidence-based Chinese Medicine, School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China.
Front Oncol. 2022 Sep 20;12:942941. doi: 10.3389/fonc.2022.942941. eCollection 2022.
Malignant pleural effusion (MPE) is a common complication in patients with advanced lung cancer that can severely compromise the quality of life and limit life expectancy. Randomized controlled trials (RCTs) have shown that Chinese herbal injections (CHIs) may be beneficial in improving quality of life. This network meta-analysis (NMA) aims to explore several CHIs used for lung cancer patients with MPE.
Seven databases were systematically searched for eligible RCTs from inception to November 2021. The primary outcome was the clinical effective rate. Secondary outcomes were the improvement rate of Karnofsky performance status (KPS) score and incidence of adverse events (AEs). The Cochrane risk of bias 2 tool was used to assess the quality of included studies. Data analysis was performed using STATA 16.0 and R software 4.1.0. Both pairwise meta-analysis and Bayesian NMA were conducted. Competing interventions were ranked using the surface under the cumulative ranking (SUCRA) probabilities. Evidence grading was evaluated using the Confidence in Network Meta-Analysis online software (https://cinema.ispm.unibe.ch/).
A total of 44 studies involving 2,573 patients were included. The combined Huachansu injection (HCS) with intrapleural cisplatin (cis-diamminedichloro-platinum, DDP) had the highest probability of improving the clinical effective rate (SUCRA, 84.33%). The Kangai injection (KA) combined with DDP had the most improvement rate of KPS score (SUCRA, 80.82%), while the Fufangkushen injection (FFKS) alone was more likely to reduce AEs including gastrointestinal reactions (SUCRA, 89.92%), leukopenia (SUCRA, 91.85%), and chest pain (SUCRA, 98.17%). FFKS combined with DDP ranked the best in reducing the incidence of fever (SUCRA, 75.45%).
Our NMA showed that CHIs alone or combined with DDP could improve clinical effectiveness and quality of life and reduce AEs, compared to DDP alone. HSC and KA, combined with DDP, may be the most effective considering clinical effective rate and improvement of KPS score, respectively. FFKS, either used alone or in combination therapy with DDP, may be the best in reducing AEs. However, high-quality RCTs with larger sample sizes are needed to further support the evidence.
PROSPERO https://www.crd.york.ac.uk/prospero/, identifier CRD42021285275.
恶性胸腔积液（MPE）是晚期肺癌患者的常见并发症，会严重影响生活质量并缩短预期寿命。随机对照试验（RCT）表明，中药注射剂（CHIs）可能有助于改善生活质量。本网状Meta分析（NMA）旨在探讨几种用于肺癌合并MPE患者的中药注射剂。
系统检索了7个数据库，以查找从数据库建立至2021年11月的符合条件的RCT。主要结局为临床有效率。次要结局为卡氏功能状态（KPS）评分改善率及不良事件（AE）发生率。采用Cochrane偏倚风险2工具评估纳入研究的质量。使用STATA 16.0和R软件4.1.0进行数据分析。进行了成对Meta分析和贝叶斯NMA。使用累积排序曲线下面积（SUCRA）概率对竞争性干预措施进行排序。使用网络Meta分析置信度在线软件（https://cinema.ispm.unibe.ch/）评估证据等级。
共纳入44项研究，涉及2573例患者。华蟾素注射液（HCS）联合胸腔内顺铂（顺二氨二氯铂，DDP）改善临床有效率的概率最高（SUCRA，84.33%）。康艾注射液（KA）联合DDP时KPS评分改善率最高（SUCRA，80.82%），而单独使用复方苦参注射液（FFKS）更有可能降低包括胃肠道反应（SUCRA，89.92%）、白细胞减少（SUCRA，91.85%）和胸痛（SUCRA，98.17%）在内的不良事件发生率。FFKS联合DDP在降低发热发生率方面排名最佳（SUCRA，75.45%）。
我们的NMA表明，与单独使用DDP相比，中药注射剂单独使用或与DDP联合使用可提高临床疗效和生活质量，并减少不良事件。分别考虑临床有效率和KPS评分改善情况，HSC和KA联合DDP可能最为有效。FFKS单独使用或与DDP联合治疗在减少不良事件方面可能是最佳的。然而，需要更大样本量的高质量RCT来进一步支持这些证据。
PROSPERO https://www.crd.york.ac.uk/prospero/，标识符CRD42021285275。
