中药联合TACE治疗原发性肝癌疗效的系统评价

A meta-analysis on the clinical effect of combining Traditional Chinese Medicine and transcatheter arterial chemoembolization therapy for treating hepatocellular carcinoma

目的系统评价中药联合TACE治疗原发性肝癌的疗效。方法计算机检索中文数据库和英文数据库自2010年至2020年5月收录的中药联合TACE治疗原发性肝癌的RCT文献,经Cochrane风险偏倚评估手册质量评估后纳入的文献,采用Review Manager 5.3软件进行meta分析。结果检索文献共1222篇,筛选后纳入27篇,总样本量2171例。meta分析得出:中药联合TACE治疗原发性肝癌患者近期疗效以化瘀为治疗原则的疗效最佳;中药联合TACE治疗原发性肝癌对比单纯TACE治疗,患者的半年生存期虽无明显差异,但1年生存期化瘀类中药联合TACE治疗优于单纯TACE治疗;2年生存期扶正、化瘀类中药联合TACE治疗优于单纯TACE治疗,且以化瘀类中药疗效为佳;中药联合TACE治疗原发性肝癌患者Karnofsky体力状况评分(KPS)明显优于单纯TACE治疗。结论中药联合TACE治疗原发性肝癌疗效优于单纯TACE治疗,尤其以化瘀类中药联合为著。

Objective To systematically evaluate the effectiveness of Combining theatment with Traditional Chinese Medicine(TCM)and Transcatheter Arterial Chemoembolization Therapy(TACE)for hepatocellular carcinoma(HCC),and to provide a reasonable supplementary scheme for the clinical management of HCC.Methods The literature of randomized controlled clinical studies on the treatment of HCC documented in Chinese and English databases from2010 to March 2020 were searched online.The literature were screened by the quality evaluation of Cochrane handbook,and a metaanalysis was performed on the included studies with Review Manager 5.3 software.Results A total of 1222 references were retrieved,and 27 were included,with a total sample size of 2171 cases.By Meta-analysis it was shown that:1.TCM combined with TACE was superior to simple TACE in terms of short-term therapeutic effect,and the therapeutic principle of removing blood stasis with traditional Chinese medicine is the best treatment;2.Although there is no significant difference in the half year survival of patients with primary liver cancer treated by TCM in combination with TACE,the oneyear survival rate of the treatment by removing blood stasis herbs in combination with TACE is better than that of TACE alone,and the two-year survival rate of Fuzheng and removing blood stasis herbs is better than that of TACE,and the curative effect of removing blood stasis herbs is the best;3.TCM combined with TACE was superior to simple TACE in terms of KPS score,and the differences were statistically significant.Conclusion The efficacy of combining traditional Chinese medicine with TACE for HCC treatment is better than simple TACE,and the therapeutic effect of TCM for removing blood stasis is the best.More multi-center randomized controlled trials with larger sample sizes and high quality are still warranted to verify this result.