Niu Xiaotao, Gu Haoqing, Li Jingzhan, Zuo Jiaqian, Ren Wenqin, Huang Yujie, Shu Xinyan, Jiang Chao, Shu Peng
Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing, Jiangsu, China.
School of No. 1 Clinical Medical, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China.
Front Oncol. 2024 Oct 16;14:1431381. doi: 10.3389/fonc.2024.1431381. eCollection 2024.
In China, Atractylodes-containing Chinese medicines are widely used as adjuvant therapy to neoadjuvant chemotherapy (NAC) in individuals diagnosed with advanced gastric cancer (AGC). Nevertheless, the findings concerning its effectiveness are still restricted. The aim from this research was to examine the efficiency and security Atractylodes macrocephala-containing traditional Chinese medicine together with NAC in the management of AGC.
Literature was systematically searched across 8 electronic databases until September 20, 2023. Two researchers conducted a thorough review of the selected studies. The primary outcome measures included the objective response rate (ORR), disease control rate (DCR), quality of life (QOL), adverse drug reactions (ADRs), and levels of peripheral blood lymphocytes. The relevant effect estimates are as follows as risk ratios (RR) or mean differences (MD) with corresponding 95% confidence intervals (CI). Credibility of information was evaluated using the GRADE analyzer.
The results showed that solely on the basis of the accessible literature examined in NAC patients, individuals who received the therapeutic regimen containing Atractylodis Macrocephalae Chinese herbal preparations demonstrated a superior overall response rate (Relative Risk: 1.41, 95% confidence interval: 1.27-1.57, P < 0.001); DCR (RR: 1.20, 95% confidence interval: 1.13-1.27, P < 0.001), as compared to QOL (RR: 1.43, 95% confidence interval: 1.30-1.57, P < 0.001, MD: 8.47, 95% confidence interval: 7.16 - 9.77, P < 0.001); the proportions of CD3 T-cells, CD4 T-cells, CD8 T-cells, CD4CD8 T-cells were increased; and the incidence of adverse reactions was decreased. Subgroup analyses showed that oral administration of all the traditional Chinese medicines containing Atractylodes macrocephala could improve tumor efficacy. Regardless of the duration of therapy of ≥8 weeks or <8 weeks, Atractylodes macrocephala-containing traditional Chinese medicine increased the tumor response in AGC patients. Combination of Atractylodes macrocephala-containing TCM with neoadjuvant chemotherapy increased ORR and DCR; when used in conjunction with cisplatin, only ORR was increased.
The combination of Atractylodes macrocephala-containing herbs with NAC in the treatment of AGC improves efficacy, improves prognosis, and reduces adverse effects. Nevertheless, additional high-quality randomized trials are required.
https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42023461079.
在中国，含白术的中药被广泛用作晚期胃癌（AGC）患者新辅助化疗（NAC）的辅助治疗。然而，关于其有效性的研究结果仍然有限。本研究的目的是探讨含白术的中药联合NAC治疗AGC的有效性和安全性。
系统检索了8个电子数据库，检索时间截至2023年9月20日。两名研究人员对所选研究进行了全面审查。主要结局指标包括客观缓解率（ORR）、疾病控制率（DCR）、生活质量（QOL）、药物不良反应（ADR）和外周血淋巴细胞水平。相关效应估计值如下：风险比（RR）或均值差（MD）及相应的95%置信区间（CI）。使用GRADE分析器评估信息的可信度。
结果表明，仅基于对NAC患者所查阅的现有文献，接受含白术中药制剂治疗方案的患者总体缓解率更高（相对风险：1.41，95%置信区间：1.27 - 1.57，P < 0.001）；DCR（RR：1.20，95%置信区间：1.13 - 1.27，P < 0.001），生活质量也有所改善（RR：1.43，95%置信区间：1.30 - 1.57，P < 0.001，MD：8.47，95%置信区间：7.16 - 9.77，P < 0.001）；CD3 T细胞、CD4 T细胞、CD8 T细胞、CD4/CD8 T细胞的比例增加；不良反应发生率降低。亚组分析表明，口服所有含白术的中药均可提高肿瘤疗效。无论治疗持续时间≥8周或<8周，含白术的中药均可提高AGC患者的肿瘤反应。含白术的中药与新辅助化疗联合使用可提高ORR和DCR；与顺铂联合使用时，仅ORR增加。
含白术的中药与NAC联合治疗AGC可提高疗效，改善预后，并减少不良反应。然而，仍需要更多高质量的随机试验。
