| Objectives To map the current status and development trends of traditional Chinese medicine for gastric cancer;to evaluate the evidence quality of clinical randomized controlled trials and meta-analyses of traditional Chinese medicine for gastric cancer;and to explore the molecular mechanisms of traditional Chinese medicine for gastric cancer through network pharmacology methods.Eventually,this study is anticipated to provide references for clinical practitioners and related researchers.Methods 1)Scientometrics:The BICOMS-2 software and related auxiliary tools were used to map the key features of the Chinese and English publications on traditional Chinese medicine for gastric cancer;2)Overview:Eight commonly used electronic databases were systematically searched to collect meta-analyses of traditional Chinese medicine for gastric cancer.PRISMA(Preferred Reporting Items for Systematic review and Meta-Analyses)and AMSTAR(A MeaSurement Tool to Assess systematic Review)tools were used to assess the reporting quality and methodological quality of included meta-analyses.Univariate and multivariate linear regression methods were used to explore the potential factors associated with reporting quality and methodological quality,and we also used Spearman rank correlation coefficient to evaluate the correlation between report quality and methodological quality;3)Cross-sectional survey:We checked the list of references of included meta-analysis for identifying the clinical randomized controlled trials of traditional Chinese medicine for gastric cancer published in recent years(2015-2019).CONSORT(Consolidated Standards Of Reporting Trials)and ROB(Risk Of Bias)tools were used to evaluate included clinical randomized controlled trials.Univariate and multivariate linear regression methods were used to explore the potential factors associated with reporting quality and methodological quality,and Spearman rank correlation coefficient was used to evaluate the correlation between reporting quality and methodological quality;4)Network pharmacology:The key targets of traditional Chinese medicine for gastric cancer and related pathways were identified based on bioinformatics and network topology analyses,and Cytoscape 3.7.1 was used to construct a multi-dimensional network of“traditional Chinese medicines-components-targets-pathways”.Data collection and statistical analysis were performed by Stata 13.0 and Microsoft Excel 2016,and two-side P<0.05 was statistically significant.Results 1)Current research status and hotspots of traditional Chinese medicine for gastric cancer:The Chinese and English publications on traditional Chinese medicine for gastric cancer have been increasing in recent years.There are 342Chinese journals and 117 English journals publishing researches on traditional Chinese medicine for gastric cancer.However,the quality of researches is suboptimal.Many Chinese publications are published in non-CSCD(Chinese Citation Database)journals,while English SCI(Science Citation Index)journals have lower impact factors.The research subjects of traditional Chinese medicine for gastric cancer are mostly researchers from domestic universities of Chinese medicine and Chinese medicine hospitals,but the degree of cooperation is low.The researches hotspots of traditional Chinese medicine in the treatment of gastric cancer mainly include the clinical research of traditional Chinese medicine for gastric cancer and molecular mechanisms exploration in the laboratory,for example,clinical researches on traditional Chinese medicine combined with chemotherapy for prevention of metastasis of postoperative gastric cancer,and basic medical researches on the molecular mechanisms of SGC-7901 cells apoptosis induced by traditional Chinese medicine combined with chemotherapy;2)Evidence quality of meta-analyses of traditional Chinese medicine for gastric cancer:Fifty-six meta-analyses were included.Traditional Chinese medicine combined with other treatment methods(chemotherapy and nutrition therapy)can improve the prognosis of patients with gastric cancer,but reporting quality and methodological quality of included meta-analyses are not good.According to the predefined grade standards,only 42.9%(24/56)and 5.4%(3/56)of the meta-analyses meet the standards of high reporting quality and high methodological quality,respectively.Flaws in the quality of researches mainly include such as registration and protocol,literature search,the checklist of inclusion and exclusion studies,and conflict of interest statements,etc.There is a high correlation between reporting quality and methodological quality(r_s=0.76,P<0.001).Funding and pages may be the influencing factors of reporting quality and methodological quality(P<0.05);3)Evidence quality of clinical randomized controlled trials of traditional Chinese medicine for gastric cancer:One hundred and thirteen clinical randomized controlled trials were included.Traditional Chinese medicine combined with other treatment methods(chemotherapy and nutrition therapy)can improve the prognosis of patients with gastric cancer.However,the reporting and methodological quality of clinical randomized controlled trials of traditional Chinese medicine for gastric cancer were poor.According to the predefined grade criteria,no study meets the criteria for high reporting quality,and only 1.8%(2/113)of them meet the high methodological quality criteria.The main problems involve the identifiability of title,calculation of sample size,details of the random method,implementation details of the blind,registration of trial and protocol,etc.There is a moderate correlation between reporting quality and methodological quality(r_s=0.42,P<0.001).Funding and pages may be the influencing factors of reporting quality(P<0.05);4)Eight commonly used traditional Chinese medicines(Baizhu,Fuling,Yiyiren,Dangshen,Chenpi,Huangqi,Banxia and Gancao)for gastric cancer were finally included.Eventually,a"traditional Chinese medicines-components-targets-paths"network was constructed.This network contains:five traditional Chinese medicines(three traditional Chinese medicines were not involved in the regulation of key targets),Dangshen,Chenpi,Huangqi,Banxia,and Gancao;nine active ingredients such as nobiletin,naringenin,baicalein,licochalcone a,quercetin;ten key targets such as TP53,MAPK8,STAT3,TNF,EGFR;and twenty-five pathways such as Pathways in cancer,TNF signaling pathway,Proteoglycans in cancer,MAPK signaling pathway,EGFR tyrosine kinase inhibitor resistance,and many of them are related to cancer.Conclusions In recent years,the researches of traditional Chinese medicine for gastric cancer have been increasing.The combination of traditional Chinese medicine and other treatment methods(chemotherapy and nutrition therapy)can improve the prognosis of patients with gastric cancer.However,the quality of clinical randomized controlled trials and meta-analysis of traditional Chinese medicine for gastric cancer is not good.Meanwhile,the key targets and molecular mechanisms identified by network pharmacology should be the focus of related researchers.In the future,researchers focused the treatment of gastric cancer with traditional Chinese medicine should strengthen cooperation,design evidence-based research,implement evidence-based decision-making,perform evidence-based practice,optimize the allocation of medical and research resources,and improve the whole research quality of traditional Chinese medicine for gastric cancer,which will ensure that patients with gastric cancer benefit from traditional Chinese medicine research to extend survival and improve quality of life. |
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