Systematic Review And Network Meta-analysis Of Traditional Chinese Medicine Injection Combined With Cisplatin Intraperitoneal Infusion In The Treatment Of Cancerous Ascites

1 OBJECTIVE AND SIGNIFICANCETo systematically evaluate the efficacy and safety of traditional Chinese medicine injections combined with cis-Dichlorodiammine platinum intraperitoneal perfusion in the treatment of cancerous ascites,and to analyze the efficacy and safety of eight different traditional Chinese medicine injection assisted by intraperitoneal perfusion in the treatment of cancerous ascites,and to identify the superior varieties of traditional Chinese medicine injection intraperitoneal perfusion in the treatment of cancerous ascites.2 METHODS2.1 Meta analysisBased on "cancerous ascites","traditional chinese medicine injection","random control" as the theme words and free words to formulate a literature retrieval strategy,comprehensive retrieval eight Chinese and English databases,time from the establishment of the database to December 31,2019,while other ways to search for relevant gray literature.To collect all relevant randomized controlled trial studies,strict screening of literature that meets the criteria,use bias risk assessment tools to evaluate the quality of the included literature,extract basic characteristics and outcome index data,import RevMan5.3 and Stata 16.0 software after data formatting and processing.The heterogeneity test and combined effect quantity were carried out,and the subgroup and regression analysis were carried out according to the research characteristics.2.2 Bayesian network Meta-analysisAll the studies on the treatment of cancer ascites by traditional Chinese medicine injection combined with cisplatin intraperitoneal perfusion were searched and included in the randomized controlled trial which was in accordance with the hypothesis test of quality,similarity and consistency.Based on the Monte Carlo effect model of Bayes Markov chain,the mesh meta analysis was carried out,using R software gemtc package,WinBUGS and Stata 16.0 software makes statistics and Analysis on the outcome data of each RCT.To draws the network evidence chart and contribution chart of each treatment measure comparison,calculates the ranking probability and cumulative probability of each outcome index of different traditional Chinese medicine injection combined with cisplatin intraperitoneal perfusion treatment,calculates the area under the curve,and predicts the possibility of ranking the efficacy and safety indexes of different traditional Chinese medicine injection.3 RESULTS3.1 Meta analysisThere were 35 studies that met the standard,including 2490 patients with canc erous ascites,1224 patients in the control group,1266 patients in the treatment group,involving 9 kinds of traditional Chinese medicine injection.Studies with a low bias risk of ?3 accounted for 20%,and the modified Jadad score was about 3-4.The results of meta analysis showed that:compared with cisplatin alone,the total effective rate of traditional Chinese medicine injection combined with cisplatin intraperitonea 1 perfusion in the treatment of cancerous ascites as follows,The total clinical effectiv e rate OR=3.38(95%CI[2.79,4.09]),Z=12.57(p<0.00001),The improvement rate of quali ty of life OR=3.72(95%CI[2.79,4.96])Z=8.97(p<0.00001),The incidence of myelosuppr ession OR=0.36(95%CI[0.28,0.47]),Z=7.50(p<0.00001),The incidence of nausea and v omiting OR=0.33(95%CI[0.26,0.42]),Z=8.92(p<0.00001),The incidence of hepatorenal toxicity OR=0.36(95%CI[0.20,0.64]),Z=3.40(p=0.0007),The incidence of fever events OR=0.42(95%CI[0.26,0.70]),Z=3,40(p=0.0007),The incidence of abdominal pain even ts OR=0.52(95%CI[0.21,1.31]),Z=1.39(p=0.16).There was no significant difference(p>0.05)in reducing the incidence of adverse reactions of abdominal pain,the other ou tcome indicators were statistically significant(p<0.05).Based on the analysis of different subgroups of the primary tumor ascites,the r esults showed that the combination of traditional Chinese medicine injection and cis platin intraperitoneal perfusion had significant effect on the ascites caused by the pri mary tumor such as gastric cancer,liver cancer and ovarian cancer,and the internal d ifferences of each subgroups were statistically significant(p<0.05),and there was no significant heterogeneity between subgroups(p=0.90).Meta subgroup analysis of total clinical effective rate of intraperitoneal perfusion in different Chinese medicine inject ion groups:Compared with DDP group,"Aidi injection+DDP" group,"Kangai injection+DDP" group,"Kanglaite injection+DDP" group,"Elemene injection+DDP" group,"C ompound Sophora flavescens injection+DDP" group,"Polyporus polysaccharide injecti on+DDP" group,"Lentinan injection+DDP" group,"Brucea javanica oil emulsion inject ion+DDP" group,"Hedyotis diffusa injection+DDP" group,the differencese were statistic ally significant(p<0.05),and there was no significant heterogeneity between subgroups(p=0.93).Compared with DDP alone,compound Kushen injection combined with intra peritoneal perfusion has a certain effect on improve the immune function of patients and reduce tumor markers,which makes the Descriptive analysis of the outcome in dicator.Regression analysis showed that different primary foci,course of treatment and frequency of medication,dosage and sample size had little effect on the results of t his study.A case study of clinical effectiveness suggests that Egger study has no ob vious publication bias3.2 Bayesian network Meta-analysisFinally,31 quantitative analysis studies are included.There are 8 kinds of traditio nal Chinese medicine injection,including Aidi injection,Kangai injection,Kanglaite injection,Elemene injection,compound Sophora flavescens injection,Polyporus polys accharide injection,lentinan injection and Brucea javanica oil emulsion injection,wh ich are respectively combined with DDP by intraperitoneal perfusion.Nine kinds of i ntervention measures of intraperitoneal perfusion with DDP alone.Bayesian net-work Meta analysis results show that:?Clinical effective percentage:DDP+Elemene injecti on(70.8%)>DDP+Compound Sophora flavescens injection(67.8%)>DDP+Kanglaite inj ection(65.9%)>DDP+Brucea javanica oil emulsion injection(58.6%)>DDP+Polyporus p olysaccharide injection(57.1%)>DDP+Aidi injection(48.4%)>DDP+Lentinan injection(41.7%)>DDP+Kangai injection(39.2%)>DDP(0.5%);?Quality of life improvement rat e:DDP+Polyporus polysaccharide injection(75.7%)>DDP+Aidi injection(59.8%)>DDP+Kanglaite injection(56%)>DDP+Brucea javanica oil emulsion injection(54.2%)>DDP+Compound Sophora flavescens injection(53%)>DDP+Lentinan injection(50.9%)>DDP(0.5%);?Reducing the incidence of adverse reactions bone marrow suppression:DD P+Aidi injection(89.6%)>DDP+Brucea javanica oil emulsion injection(57.6%)>DDP+C ompound Sophora flavescens injection(57.5%)>DDP+Polyporus polysaccharide injectio n(57.5%)>DDP+Kanglaite injection(55.7%)>DDP+Lentinan injection(47%)>DDP+Elem ene injection(46.9%)>DDP+Kangai injection(28.9%)>DDP(9.4%);?Reducing the inci dence of adverse reactions to nausea and vomiting:DDP+Aidi injection(75.2%)>DDP+Elemene injection(66%)>DDP+Compound Sophora flavescens injection(58.5%)>DD P+Kanglaite injection(58.1%)>DDP+Polyporus polysaccharide injection(57.3%)>DDP+Brucea javanica oil emulsion injection(56.7%)>DDP+Kangai injection(48%)>DDP+Le ntinan injection(24.3%)>DDP(5.9%);?Results of clustering analysis:Compound Soph ora flavescens injection and Kanglaite injection have relative comprehensive advanta ges in improving clinical efficacy and reducing the adverse effects of myelosuppress ion at the same time.Compound Sophora flavescens injection and Elemene injection have relative comprehensive advantages in improving clinical efficacy and reducing adverse reactions of nausea and vomiting at the same time.Kanglaite injection and Compound Sophora flavescens injection have comparative advantages in improving c linical total effective rate and quality of life improvement rate at the same time.Aid i injection has a comparative advantage in reducing the incidence of adverse reactio ns of myelosuppression and nausea and vomiting at the same time.Compared with Kangai injection+DDP,Aidi injection+DDP(OR=0.19,95%CI[0.04,0.78])can signi ficantly reduce the incidence of myelosuppression(p<0.05)4 CONCLUSIONCompared with the treatment of DDP alone,traditional Chinese medicine injection combined with DDP intraperitoneal perfusion can significantly improve the total clinical effective rate of patients with cancer ascites.There is no significant difference in the efficacy of different primary ascites,such as gastric cancer,liver cancer,ovarian cancer and so on.At the same time,it can improve the quality of life and reduce the incidence of myelosuppression,nausea and vomiting.Among them,Elemene injection may have a comparative advantage in improving the short-term efficacy,Aidi injection may have a greater possibility in reducing the incidence of adverse reactions,and Compound Kushen injection may have a comprehensive advantage in improving the clinical efficacy and reducing adverse reactions.