| Objective To assess the clinical effects and safety of Chinese herb injection(CHI) combined with chemotherapy for Gastric Cancer (GC).Methods The randomly controlled trials (RCTs) of CHI were searched from PubMed (1966-2013.4), EMBASE.com (1974-2013.4), Cochrane Library(-2013.4), Web of Science (1980-2013.4), China National Knowledge Infrastructure (1994-2013.4), Chinese Scientific Journals Fulltext Database (1989-2013.4), Chinese Biomedical Literature Database (1978-2013.4), Wan-Fang Database (1997-2013.4) and Chinese Science Citation Database (1989-2013.4), and the related references and websites were also traced. The RCTs were screened according to the predefined inclusion and exclusion criteria, and the related items were used to assess the quality of RCTs. The data were analyzed by ADDIS, GRADEpro, and Review Manger softwares.Results①A total of129articles were identified including10603patients and eleven CHI. The number of CHI combined with chemotherapy for GC was increasing annually because109articles concerning RCTs were published in2007-2013when compared with20in1999-2006. Although93.80%(121/129) of studies were identified as RCT by "random", only14.73%(19/129) reported the detailed information based on the methods of randomization.1.55%(2/129) mentioned the blinding.44.19%(57/129) RCTs provided at length the information about the rate and reason of the drop-out while25.58%(33/129) gave the number but no reason of the drop-out.80.62%(104/129) described the inclusion and exclusion criteria.91.47%(118/129) provided the information about adverse events.96.90%(125/129) RCTs reported the methods of statistical analysis.②The result of meta analysis showed that compared with the chemotherapy, the aidi injection combined with chemotherapy could improve the efficacy and quality of life and decrease the damage of liver function and gastrointestinal reaction; shenqifuzheng injection combined with chemotherapy could improve the efficacy and quality of life and decrease the nausea and vomiting and leukopenia (Ⅲ-Ⅳ); bufotoxin injection combined with chemotherapy could decrease the nausea and vomiting and leukopenia (Ⅲ-Ⅳ); delisheng injection combined with chemotherapy could improve the efficacy and quality of life and decrease the nausea and vomiting and leukopenia(Ⅲ-Ⅳ); compound matrine injection combined with chemotherapy could improve the efficacy and quality of life and decrease the nausea and vomiting(Ⅲ-Ⅳ), damage of liver function, damage of kidney function and leukopenia(Ⅲ-Ⅳ); cinobufacini injection combined with chemotherapy could improve the efficacy and quality of life; astragalus polysaccharides injection combined with chemotherapy could improve the efficacy and quality of life and decrease gastrointestinal reaction; kangai injection combined with chemotherapy could improve the efficacy and quality of life and decrease the nausea and vomiting, damage of liver function; kanglaite injection combined with chemotherapy could improve the efficacy and quality of life and decrease the leukopenia(III-IV); ginseng polysugar injection combined with chemotherapy could improve the efficacy and quality of life; yadanziyouru injection combined with chemotherapy could improve the efficacy and quality of life and decrease the gastrointestinal reaction. Downgrade quality of evidence were risks of bias, indirectness and inconsistency. If it was between low and medium level, herb injections were not recommended.③The result of network meta analysis showed that compared with FOLFOX alone, kanglaite injection combined with FOLFOX regimen, astragalus polysaccharides injection combined with FOLFOX regimen, shenqifuzheng injection combined with FOLFOX regimen, yadanziyouru injection combined with FOLFOX regimen could furthest strengthen the efficacy, improve the quality of life, reduce nausea and vomiting, and reduce incidence of leukopenia (Ⅲ-Ⅳ), respectively. Based on docetaxel, delisheng injection combined with docetaxel, compound matrine injection combined with docetaxel and yadanziyouru injection combined with docetaxel could improve the efficacy and quality of life and decrease the nausea and vomiting. Based on taxol, aidi injection combined with taxol, shenqifuzheng injection combined with taxol and kangai injection combined with taxol could improve the quality of life, reduce nausea and vomiting, and reduce incidence of leukopenia (Ⅲ-Ⅳ). Based on capecitabine, aidi injection combined with capecitabine, yadanziyouru injection combined with capecitabine and compound matrine injection combined with capecitabine could improve the efficacy, improve the quality of life, reduce nausea and vomiting, and reduce incidence of leukopenia (Ⅲ-Ⅳ).Conclusion The data indicate that the quality of methodological reporting in RCTs on CHI for GC has not got improved over time, and still remains poor. Chinese authors and journals should adopt and keep up with the CONSORT statement to improve the reporting quality of RCTs in this field. Compared with chemotherapy, CHI combined with chemotherapy can improve the quality of life and decrease the nausea and vomiting and leukopenia. Aidi injection, shenqifuzheng injection, yadanziyouru injection and compound matrine injection are more efficient than other seven CHI injections. |
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