中药配合放疗治疗中晚期肝细胞癌的系统评价

Traditional Chinese medicine combined with radiotherapy for treatmnet of intermediate and advanced stage hepatocellular carcinoma: a systematic review

目的评价中药配合放疗治疗中晚期肝细胞癌(HCC)的有效性和安全性。方法计算机检索中国期刊全文数据库、中文科技期刊全文数据库、万方数据库、中国生物医学文献数据库、Cochrane图书馆、Pub Med、Embase,纳入有关中药配合放疗治疗中晚期HCC的随机对照试验和队列研究,参照Cochrane手册5.1.0版的文献质量评价标准评估纳入研究的质量,并通过Rev Man 5.2软件进行统计分析。结果共纳入15个随机对照试验和5个队列研究,共1 475例患者。Meta分析结果显示:中药配合放疗治疗中晚期HCC在近期疗效[RR=1.32,95%CI(1.15,1.50),P<0.001]和1、2、3年生存率[RR=1.28,95%CI(1.13,1.44),P<0.001;RR=1.33,95%CI(1.08,1.63),P=0.007;RR=1.65,95%CI(1.14,2.37),P=0.007]方面优于单纯放疗;中药配合放疗治疗中晚期HCC的血液学毒性反应发生率和放射性肝损伤发生率也显著低于单纯放疗(P均<0.001)。结论中药配合放疗治疗中晚期HCC,可以提高放疗的近期疗效,延长患者的生存期,并且能减少放疗的毒副作用。但由于纳入研究的质量不高,尚需多中心、大样本、高质量的临床试验来进一步验证。

Objective To evaluate the efficacy and safety of traditional Chinese medicine（ TCM） combined with radiotherapy for the treatment of intermediate and advanced stage hepatocellular carcinoma（ HCC）. Methods The databases of computer retrieve included CNKI,VIP,Wanfang Database,CBM Disc,Cochrane Library,Pub Med and Embase. And randomized controlled trials（ RCTs） and cohort studies about TCM combined with radiotherapy for the treatment of intermediate and advanced stage HCC were collected. The quality assessment of included studies was performed based on the literature quality assessment criteria recommended by the Cochrane handbook（ ver. 5. 1. 0）,and a statistical analysis was conducted using Rev Man 5. 2 software. Results Fifteen RCts and five cohort studies were involved,which consisted of 1475 patients. Meta-analysis revealed that the short-term efficacy（ RR = 1. 32,95% CI（ 1. 15,1. 50）,P〈0. 001）as well as the 1-,2- and 3-year survival rates（ RR = 1. 28,95% CI（ 1. 13,1. 44）,P〈0. 001; RR = 1. 33,95% CI（ 1. 08,1. 63）,P = 0. 007;RR = 1. 65,95% CI（ 1. 14,2. 37）,P = 0. 007,respectively） in patients treated with TCM combined with radiotherapy was significantly superior for intermediate and advanced stage HCC compared with patients treated with radiotherapy alone. Compared with patients treated with radiotherapy alone,patients treated with TCM combined with radiotherapy had significantly lower incidences of hematological toxic reaction and radiation-induced liver injury for intermediate and advanced stage HCC（ all P〈0. 001）. Conclusion TCM combined with radiotherapy can improve short-term efficacy of radiotherapy,prolong survival time and reduce the incidence of radiotherapy-related toxic and adverse reactions for patients with intermediate and advanced stage HCC. The qualities of included studies are not high,therefore,more multi-center,large-sample and high-quality clinical trials are needed to further confirm this conclusion.