Network Meta-analysis Of 9 Chinese Herb Injection Combined With Transcatheter Arterial Chemoembolization For Hepatocellular Carcinoma

Objective:We aimed to evaluate the effectiveness and quality of life improvement of 9traditional Chinese herb injections combined with transcatheter arterial chemoembolization in the treatment of hepatocellular carcinoma by using network Meta-analysis.Methods:We searched the Cochrane Library,Pub Med,EMBASE and CBM,VIP Chinese Journal Database,Wanfang database and CNKI database.Retrieval time for each database was up to December 30,2016.We screened literature according to pre-established inclusion and exclusion criteria,and evaluated the quality of the included studies.Review Manager 5.3 and R software were used for statistical analysis and results of RCTs were combined and sorted by network Meta-analysis.Results:(1)86 RCTs including 5791 patients were finally included.All studies did not mention whether or not the blind method and allocation concealment was conduct,only eight studies reported the random distribution method in detail,four of studies described the number and cause of loss or withdrawal;a total of 48 studies reported quality of life of patients,26 reported the information of occurrence of reduced(2)leukocytes in patients and the 16 studies provided of patients with the incidence of nausea and vomiting.(2)Network Meta-analysis based on probabilistic ranking results showed that,total effective rate ranked from high to low as follows,Cantharidin injection(OR=5.60,95%CI:3.55-8.84;P=0.920),Kanglaite Injection(OR=5.66,95%CI:2.96-10.82;P=0.906),Elemene injection(OR=3.34,95%CI:1.77-6.32;P=0.601),Compound Kushen injection(OR=2.86,95%CI:1.84-4.46;P=0.478),Brucea javanica oil injection(OR=2.85,95%CI:1.94-4.19;P=0.475),Cinobufaciniinjection(OR=2.79,95%CI:2.02-3.85;P=0.452),Delisheng injection(OR=2.74,95%CI:1.22-6.15;P=0.448),Aidi injection(OR=2.71,95%CI:2.12-3.47;P=0.418),Kangai injection(OR=2.37,95%CI:1.53-3.66;P=0.301).(3)Improvement of quality of life ranked from high to low order showed that,Aidi Injection(OR=3.06,95%CI:1.25-7.47;P=0.669),Kangai injection(OR=3.38,95%CI:0.50-22.74;P=0.655),Kanglaite Injection(OR=2.09,95%CI:0.21-21.38;P=0.599),Delisheng injection(OR=3.33,95%CI:0.05-210.09;P=0.586),Cinobufagin injection(OR=2.39,95%CI:0.47-12.26;P=0.556),Brucea javanica oil injection(OR=2.25,95%CI:0.74-6.81;P=0.547),Cantharidin injection(OR=1.82,95%CI:0.62-5.35;P=0.464),Elemene Injection(OR=2.20,95%CI:0.08-62.31;P=0.403),Compound Kushen injection(OR=1.26,95%CI:0.37-4.27;P=0.325).(4)Ranking of clinical benefits:Kanglaite Injection(OR=3.33,95%CI:1.50-7.38;P=0.795),Elemene Injection(OR=3.32,95%CI:1.11-9.99;P=0.0.750),Cantharidin injection(OR=2.72,95%CI:1.494.95;P=0.689),Delisheng injection(OR=2.17,95%CI:0.99-4.76;P=0.504),Compound Kushen injection(OR=2.14,95%CI:1.26-3.64;P=0.493),Kangai injection(OR=2.14,95%CI:1.02-4.48;P=0.492),Cinobufagin injection(OR=2.14,95%CI:152-3.01;P=0.489),Aidi Injection(OR=2.07,95%CI:1.51-2.81;P=0.450),Brucea javanica oil injection(OR=1.82,95%CI:1.24-2.67;P=0.329).(5)Decreasing leucocytes ranked from high to low order showed that:Compound Kushen injection(OR=0.03,95%CI:0.01-0.11;P=0.935),Delisheng injection(OR=0.13,95%CI:0.03-0.51;P=0.751),Elemene Injection(OR=0.14,95%CI:0.55-0.39;P=0.656),Cinobufagin injection(OR=0.17,95%CI:0.09-0.33;P=0.644),Brucea javanica oil injection(OR=0.20,95%CI:0.12-0.36;P=0.594),Kanglaite Injection(OR=0.29,95%CI:0.13-1.14;P=0.463),Kangai injection(OR=0.34,95%CI:0.17-0.68;P=0.394),Aidi Injection(OR=0.36,95%CI:0.25-0.52;P=0.341),Cinobufagin injection(OR=0.78,95%CI:0.30-2.02;P=0.162).(6)The results of nausea and vomiting are sorted by high to low:Brucea javanica oil(OR=0.19,95%CI:0.08-0.46;P=0.965),Aidi Injection(OR=0.26,95%CI:0.12-0.55;P=0.682),Compound Kushen injection(OR=0.34,95%CI:0.12-0.97;P=0.586),Cinobufagin injection(OR=0.43,95%CI:0.19-0.98;P=0.555),Kangai injection(OR=0.75,95%CI:0.45-1.25;P=0.355),Kanglaite Injection(OR=0.79,95%CI:0.30-2.06;P=0.338),Kanglaite Injection(OR=0.81,95%CI:0.38-1.70;P=0.296).Conclusion:Network Meta-analysis based on the efficient probabilistic ranking results showed that,Cantharidin injection,Kanglaite Injection and Elemene Injection are relatively effective compared to the other six kinds of traditional Chinese medicine injection.Based on the probabilistic ranking results of quality of life,Aidi injection,Kangai injection and Kanglaite injection in relative with other injection improve quality of life better.Kanglaite injection,Elemene injection and Cinobufagin injection is better than other seven kinds of traditional Chinese medicine in terms of improvement of clinical benefits.In terms of adverse reactions,Compound Kushen injection,Delisheng injection and Elemene Injection reduced the incidence of leukopenia superiorly to other traditional Chinese medicine injections;Brucea javanica oil injection and Aidi injection is better than the other 5 kinds of traditional Chinese medicine injection in reducing nausea and vomiting.