| ObjectiveEvaluation and analysis of the curative effect of Traditional Chinese Medicine (TCM) combined with transcatheter arterial chemoembolization (TACE) for the treatment of primary liver cancer. Outcome indicators for measuring the effectiveness evaluation have included the effect of recent changes in tumors after treatment, the improve of the patient’s clinical symptoms, the rate of change of the patient’s quality of life (KPS score); the1,2,3-year survival rate of patients and the rate of adverse reaction.MethodsThe research uses Cochrane systematic review methods to study information database of VIP Chinese scientific journals, CNKI Chinese Academic Journal as well as Chinese Journal, China Doctoral Dissertations Full-text Database within10years (2003-2012). Select researches on Chinese medicine combined with TACE for the treatment of primary liver cancer which are suitable for the inclusion and exclusion criteria of CONSORT statement and Jadad scale. Statistical software RevMan5.2was used for meta-analysis and subgroup analysis.Results104reports with7711patients in randomized trial of TCM combined with TACE for the treatment of primary liver cancer were made. The patients were divided into two groups:experimental group with3951patients and control group with3760patients. Results from meta-analysis articles no publication bias and sensitivity analysis were statistically stable and reliable, as follows:1. Overall effect of Traditional Chinese Medicine combined with conventional treatment for primary liver cancer1.1. The rate of changes in tumorsMeta-analysis showed that results statistical tests did not indicate heterogeneity.After treatment, TCM combined with TACE has effected in recent changes in tumors more than that TACE alone therapy. The differences between the two groups have statistical significance with RR (95%C1)1.33(1.27,1.40), P<0.001. Meanwhile, TCM combined with TACE can control the rate of tumors progression with RR (95%C1)0.54[0.49,0.60], P<0.001.1.2. The rate of changes of the patient’s quality of life (KPS score)TCM combined with TACE has improved the patient’s KPS score more than that TACE alone therapy. The differences between the two groups have statistical significance with RR (95%C1)1.81(1.67,1.95), P<0.001). It can reduce the patient’s quality of life with lower KPS score. The differences between the two groups have statistical significance with RR (95%C1)0.37(0.32,0.43), P<0.001。1.3. The survival rate of patientsAfter treatment, TCM combined with TACE has improved1,2and3-year survival rate of patients more than that TACE alone therapy. The differences between the two groups have statistical significance with RR (95%C1)=1.35(1.28,1.44),1.73(1.54,1.94) and2.26(1.71,2.99), P<0.001。1.4. The improve of the patient’s clinical symptoms and the rate of adverse reactionMeta-analysis also showed that:①TCM combined with TACE has improved patient’s clinical symptoms more than that TACE alone therapy.There were a statistically significant difference between the two groups with RR (95%C1)1.54(1.12,2.12), P<0.001.②TCM combined with TACE has decreased the rate of adverse reaction of patients more than that TACE alone therapy. There were a statistically significant difference between the two groups with RR<1, P<0.001. Meta-analysis indicated a high degree of heterogeneity of adverse reaction, therefore the results of adverse reaction was not reliable. Because the different chemotherapy drugs and TCM prescription were used in almost of researches, so that the results of adverse reaction was high degree of heterogeneity.2. The effect of TCM combined with TACETCM combined with TACE has8main kinds:Aidi injection, Fufang kushen injection, Huachansu injection, Kangai injection, Yadanzi injection, Jinlong capsule, syndrome differentiation and treatment, and Shuganjianpi method TCM uses8main kinds to strengthen the body’s resistance against the disease. Meta-analysis results as follows:2.1. The rate of changes in tumors2.1.1. The effect of recent changes in tumorsThe seven kinds of TCM combined with TACE were clearly more effective than TACE alone therapy for the treatment of primary liver cancer except Kangai injection. There were a statistically significant difference between the two groups with P<0.05.2.1.2. The rate of tumors progressionThe seven kinds of TCM combined with TACE were clearly more effective than TACE alone therapy for the treatment of primary liver cancer except Kangai injection. There were a statistically significant difference between the two groups with(95%Cl) RR<1, P<0.05. There were not a statistically significant difference between the two groups in the effect of Kangai injection with RR<1, P=0.3.2.2. The rate of change of the patient’s quality of life (KPS score)2.2.1. Improve the rate of KPS scoreThere are six main kinds of TCM:Aidi injection, Fufang kushen injection, Kangai injection, Yadanzi injection, syndrome differentiation and treatment, and Shuganjianpi method. The six main kinds of TCM combined with TACE has improved the patient’s quality of life and the rate of KPS score were higher than TACE alone therapy for the treatment of primary liver cancer. There were a statistically significant difference between the two groups with RR>1, P<0.05.2.2.2.The rate of lower KPS scoreThere are five main kinds of TCM:Aidi injection, Fufang kushen injection, Kangai injection, Yadanzi injection and Shuganjianpi method. The five main kinds of TCM combined with TACE can reduce the patient’s quality of life with lower the rate of KPS score. There were a statistically significant difference between the two groups with RR<1, P<0.01.2.3.The survival rate of patientsThere are five kinds of TCM:Aidi injection, Fufang kushen injection, Kangai injection, Huachanshu injection, syndrome differentiation and treatment, and Shuganjianpi method. The five kinds of TCM combined with TACE has improved1,2and3-year survival rate more than that TACE alone therapy for the treatment of primary liver cancer.There were a statistically significant difference between the two groups with RR>1, P<0.05. There were not any reports on Aidi injection for3-year survival rate.3. The stratification in meta-analysis of the effect of chemotherapy drugs in combined with TCM.The scheme of interventional chemotherapy drugs treatment (TACE):FMD scheme has included fluorouracil, mitomycin and cisplatin; FMAD scheme has included fluorouracil, mitomycin, epirubicin or pharmorubicin and cisplatin; FMA scheme has included fluorouracil, mitomycin and epirubicin or pharmorubicin.Outcome indicators for measuring the effectiveness evaluation have included the rate of change in tumors, the rate of lower KPS score; the1,2year survival in patients.The resuls of stratification in meta-analysis:3.1. The rate of changes in tumors3.1.1. The effect of recent changes in tumorsThe effect of recent changes in tumors by using TCM combined with three chemotherapy drugs regimens (TACE) were clearly more effective than that alone TACE therapy.There were a statistically significant difference between the two groups with RR(95%C1)1.32(1.21,1.43), P<0.05. TCM combined with FMAD scheme was more effective for the treatment of primary liver cancer with RR(95%C1)1.36(1.19,1.55), P<0.001.3.1.2. The rate of tumors progressionTCM combined with three chemotherapy drugs regimens (TACE) were clearly more effective than TACE alone therapy for lower the rate of patient’s tumors progression. There were a statistically significant difference between the two groups with (95%C1)0.51(0.43,0.62), P<0.05. The FMD and FMA schemes have the same effect on lower the rate of patient’s tumors progression.3.2. Lower the rate of KPS score TCM combined with three chemotherapy drugs schemes (TACE) can reduce the patient’s quality of life with lower the rate of KPS score more than that TACE alone therapy. The differences between the two groups have statistical significance of with RR (95%Cl)0.33(0.24,0.46), P<0.001. FMAD scheme with RR (95%C1) lowest0.29(0.17,0.51), P<0.001.3.3. The1,2-year survival rate of patientsAfter treatment, TCM combined with three schemes (TACE) have improved1,2-year survival rate of patients more than that TACE alone therapy. The differences between the two groups have statistical significance with RR (95%Cl)=1.28(1.17,1.39);1.75(1.46,2.09), P<0.05. The FMAD and FMD schemes have improved1,2-year survival rate with RR(95%Cl)2.33(1.11,4.91);2.05(1.55,2.72),P<0.05.Conclusion1.TCM combined with TACE was more effective than TACE alone therapy for the treatment of primary liver cancer.2. Effect of TCM:TCM combined with TACE has8main kinds. Meta-analysis showed that the seven kinds of TCM combined with TACE were clearly short-term effect more effective than that TACE alone therapy for the treatment of primary liver cancer except Kangai injection. Especially, Aidi injection, Fufang kushen injection, Syndrome differentiation and Treatment, and Shuganjianpi method which be able to support extensive clinical application.3. The curative effect of chemotherapy drugs in combined with TCMThe scheme of interventional chemotherapy drugs treatment (TACE):FMD scheme has included fluorouracil, mitomycin and cisplatin; FMAD scheme has included fluorouracil, mitomycin, epirubicin or pharmorubicin and cisplatin; FMA scheme has included fluorouracil, mitomycin and epirubicin or pharmorubicin. In which, the effect of FMAD therapy was better. |
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