Traditional Chinese Medicine plus Transcatheter Arterial Chemoembolization for Unresectable Hepatocellular Carcinoma: A Meta-analysis of Randomized Controlled Trials_Chinese Journal of Evidence-Based Medicine

Authors：

MENG Maobin ¹ , CUI Yaoli ² , GUAN Yongsong ³ , SHE Bin ¹ ,  ZHANG Ruiming ¹

1. Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, China2. Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu 610041, China3. Department of Radiation Oncology, West China Hospital, Sichuan University, Chengdu 610041, China;

Corresponding author：

ZHANG Ruiming, Email: zhruim-001@163.com

Keywords：

Unresectable hepatocellular carcinoma; Traditional Chinese Medicine; Transcatheter arterial chemoembolization; Randomized controlled trial; Meta analysis

DOI：

10.7507/1672-2531.20080007

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Objective　 To evaluate the effectiveness and safety of traditional Chinese medicine (TCM) plus transcatheter arterial chemoembolization (TACE) compared with TACE alone, in the treatment of unresectable hepatocellular carcinoma (HCC).
Methods　 The Cochrane Library, MEDLINE, EMBASE, CANCERLIT, CBM, CNKI and VIP were searched electronically. Relevant journals and conference proceedings were also handsearched. The quality of included studies was assessed according to the criteria recommended by the Cochrane Handbook for Systematic Reviews of Interventions, and meta-analyses were performed for homogeneous studies using The Cochrane Collaboration’s RevMan 4.2.10 software. Subgroup analyses by frequency of TACE ( lt;3 or ≥3 times) were also performed.
Results　 Thirty seven trials, all published in China, involving 2 653 participants were included. The quality of 2 studies was graded B (medium) and that of the other 35 was graded C (low). Meta-analyses showed that TCM plus TACE, compared with TACE alone, could significantly improve survival, tumor response (complete and partial), quality of life and clinical symptoms, and was also associated with a lower incidence of adverse reactions. Subgroup analyses indicated that, patients with less than three TACE had more significant improvement in survival and clinical symptoms, while patients with three or more TACE had more significant improvement in tumor response and quality of life. The incidence of adverse reactions was similar between these two different frequencies of TACE.
Conclusions　 The treatment regimen of TCM plus TACE is superior to TACE alone in patients with unresectable HCC. As the existing data have a high risk of bias, the current evidence is insufficient to define the efficacy of the combination treatment, and further large-scale, high-quality randomized controlled trials are needed.

Citation： MENG Maobin,CUI Yaoli,GUAN Yongsong,SHE Bin,ZHANG Ruiming. Traditional Chinese Medicine plus Transcatheter Arterial Chemoembolization for Unresectable Hepatocellular Carcinoma: A Meta-analysis of Randomized Controlled Trials. Chinese Journal of Evidence-Based Medicine, 2008, 08(1): 21-31. doi: 10.7507/1672-2531.20080007 Copy

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1. American Cancer Society: Cancer Facts and Figures 2007. Atlanta, Ga; American Cancer Society 2007. Available from: URL: http://www.cancer.org/docroot/home/index.asp.
2. Ministry of health of the people republic of China: Retrospective Sampling Survey on Malignant Tumor in China from 1990 to 1992. Available from: URL: http://www.moh.gov.cn/open/statistics/digest04/s78.htm.
3. Pisani P, Parkin M, Bray F, et al. Estimates of the worldwide mortality from 25 cancers in 1990. Int J Cancer, 1999, 83: 18-29.
4. Simonetti RG, Cammà C, Fiorello F, et al. Hepatocellular carcinoma: a worldwide problem and major risk factor. Dig Dis Sci, 1991, 36: 962-972.
5. Geschwind JF, Ramsey DE, Choti MA, et al. Chemoembolization of Hepatocellular Carcinomaz: Results of a Metaanalysis. Am J Clin Oncol, 2003, 26(4): 344-349.
6. Venook AP, Stagg RJ, Lewis BJ, et al. Chemoembolization for hepatocellular carcinoma. J Clin Oncol, 1990, 8(6): 1108-1114.
7. Bülent A, ìzzet R. Hepatocellular carcinoma: treatment with transcatheter arterial chemoembolization. European J of Radiology, 1999, 32: 86-89.
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9. Alderson P, Green S, Higgins JPT, editors. Cochrane Reviewer’s Handbook 4.2.2 (updated March 2004). The Cochrane Library.Chichester, UK: John Wiley & Sons, Ltd, 2004.
10. Higgins JPT, Thompson SG. Quantifying heterogeneity in a metaanalysis. Stat Med, 2002, 21(11): 1539-1558.
11. Egger M, Davey Smith G, Schneider M, et al. Bias in meta-analysis detected by a simple,graphical test. BMJ, 1997, 315(7109): 629–634.
12. 林丽珠, 周岱翰, 刘琨, 等. 参桃软肝丸方合羟基树碱介入治疗大肝癌的预后因素分析. 中国中西医结合杂志, 2005, 26(1): 8-11.
13. 田秀岭. 艾易舒注射液联合介入治疗中晚期肝癌36例疗效分析. 中原医刊, 2006, 33(6): 32-34.
14. 邬晓东, 金学东, 刘淑梅, 等. 中药护肝软坚方对II期, III期原发性肝癌肝动脉化疗栓塞增效减毒作用观察. 北京中医药大学学报, 2003, 26(1): 67-68.
15. 于起涛, 蒙志斌. 华蟾素联合肝动脉插管灌注治疗中晚期肝癌的临床研究. 广西中医学院学报, 2004, 7(3): 35-37.
16. 龙建安, 徐毅, 汤启勋, 等. 肝活喜片配合肝动脉化疗栓塞治疗II期, III期原发性肝癌的临床研究. 中西医结合肝病杂志, 2001, 11(5): 275-277.
17. 张玉芳, 焦智民, 米巧云, 等. 中药配合肝动脉介入治疗中晚期肝癌. 中国中西医结合外科杂志, 2000, 6(3): 179-180.
18. 李文华, 尹军平, 王兴卉, 等. 联合华蟾素栓塞化疗中晚期肝癌的疗效观察. 世界临床, 2006, 27(5): 304-306.
19. 赵希文, 黄克江. 参芪胶囊结合介入疗法治疗原发性肝癌的临床观察. 中医药学报, 2005, 33(3): 28-29.
20. 文汉英, 彭轶霞. 中西医结合治疗中晚期肝癌32例. 陕西中医, 2006, 21(7): 26-28.
21. 郭添胜, 黄喜福, 曹小龙. 槐耳颗粒联合介入治疗原发性肝癌的疗效观察. 实用医学杂志, 2005, 21(16): 1846-1847.
22. 徐中伟, 王文海, 束家和, 周荣耀. 六君子汤加味在原发性肝癌介入治疗中的应用. 浙江中西医结合杂志, 2000, 10(12): 711-713.
23. 王瑞平, 杨晨. 肝积颗粒合介入治疗原发性肝癌的临床观察. 安徽中医学院学报, 2002, 21(6): 9-11.
24. 杨家梅. 艾迪注射液联合介入栓塞治疗原发性肝癌. 医药论坛杂志, 2006, 27(20): 26-27.
25. 谭晓云, 龚红卫. 艾迪注射液联合肝动脉化疗及栓塞治疗原发性肝癌临床疗效观察. 肿瘤防治研究, 2005, 35(5): 313-314.
26. 李瑞君. 艾迪注射液联合肝动脉介入治疗原发性肝癌疗效观察. 中原医刊, 2005, 14(7): 69.
27. 向德兵, 谢得印, 王东, 等. 得力生注射液联合肝动脉化疗栓塞治疗原发性肝癌的临床研究. 现代肿瘤医学, 2006, 14(7): 861-862.
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29. 冯坚. 中药和介入治疗原发性肝癌35例. 广西中医学院学报, 2002, 5(3): 51-52.
30. 刘新兰, 朱秀琴. 岩舒治疗肝癌的临床观察. 宁夏医学院学报, 2002, 24(2): 105-106.
31. 吴万银, 郭伟剑, 林钧华. 平消胶囊配合经肝动脉灌注化疗栓塞治疗原发性肝癌25例. 中西医结合肝病杂志, 2001, 11(1): 50-51.
32. 田华琴, 梁贵文, 陶银, 等. 中药配合介入治疗肝癌的临床研究. 河南中医药学刊, 2001, 16(1): 47-48.
33. 朱晓锋. 康莱特注射液联合介入化疗栓塞治疗原发性中晚期肝癌. 肿瘤基础与临床, 2006, 19(2): 132-134.
34. 张士友, 耿乃志, 刘艳娥, 等. 肝动脉灌注化疗加栓塞结合AC—Ⅲ注射液治疗原发性肝癌的临床研究. 中医药信息, 1996, (4): 29-31.
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36. 吴建新. 一贯煎加味配合TACE治疗原发性肝癌的远期疗效观察. 浙江中西医结合杂志, 1999, 9(2): 100-101.
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38. 周炳刚, 范玉诼, 景生虹, 等. 平消胶囊联合介入栓塞化疗术治疗中晚期肝癌. 陕西肿瘤医学, 1999, 7(3): 159-161.
39. 曹贵文, 王秀春, 张凤莲, 等. 自制肝复康胶囊辅助治疗HCC临床观察. 山东医药, 2005, 45(2): 13-14.
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Chinese Journal of Evidence-Based Medicine

Traditional Chinese Medicine plus Transcatheter Arterial Chemoembolization for Unresectable Hepatocellular Carcinoma: A Meta-analysis of Randomized Controlled Trials

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