逍遥散加减方联合化疗治疗乳腺癌的Meta分析

Meta-analysis of Xiaoyaosan plus or minus prescription unite chemotherapy for treating breast cancer

目的通过大数据系统分析逍遥散加减方联合化疗对乳腺癌治疗的临床应用价值。方法通过VIP、CBM、WanFang、CNKI、PubMed、Embase、Cochrane图书馆数据库检索2020年10月以前有关逍遥散加减方联合化疗治疗乳腺癌文献。根据研究需求筛选文献,并进行质量评价,运用RevMan5.3软件分析数据。结果共纳入16个RCT研究文献,共1107例乳腺癌患者。Meta分析结果显示,逍遥散加减方联合化疗治疗乳腺癌对比单纯化疗组,在乳腺癌实体瘤近期疗效有效率[OR=1.74,95%CI(1.27,2.39),P=0.0006],提高患者生存质量[OR=3.75,95%CI(2.58,5.44),P<0.00001],改善患者临床证候[OR=3.69,95%CI(1.43,9.49),P=0.007],缓解患者抑郁症[MD=-11.30,95%CI(-15.66,-6.94),P<0.00001],降低患者骨髓抑制(白细胞、血小板)方面分别为[OR=0.32,95%CI(0.20,0.51),P<0.00001]、[OR=0.37,95%CI(0.20,0.67),P=0.001],减少患者恶心呕吐[OR=0.29,95%CI(0.17,0.48),P<0.00001],降低患者心脏毒性[OR=0.15,95%CI(0.06,0.37),P<0.0001]更占优势。但是在降低患者肝肾功损伤[OR=0.59,95%CI(0.29,1.21),P=0.15],及对于提高晚期乳腺癌患者3年生存率方面[OR=2.11,95%CI(0.75,5.97),P>0.05]却存在证据不足。原因考虑纳入研究数据太少,分别只有4项研究跟2项研究,且文献质量存异,在今后的研究中应该加大样本,进行大数据系统研究。结论逍遥散加减方联合化疗治疗乳腺癌可以提高乳腺癌患者实体瘤近期疗效有效率,改善患者生存质量、临床证候、抑郁症,降低骨髓抑制、恶心呕吐和心脏毒性,但降低肝肾功损伤及提高晚期乳腺癌3年生存率方面,证据不足,需加大样本研究。

Objective The clinical value of Xiaoyaosan plus or minus formula unite chemotherapy for treating breast cancer was analyzed through big data system. Methods By retrieving VIP, CBM, Wan Fang, CNKI, PubMed, Embase and Cochrane library database with the article of Xiaoyaosan plus or minus formula combined with chemotherapy for breast cancer before October 2020. The literature was filtrated through study needs, and carry on the quality evaluation, the data were analyzed with RevMan5.3 software. Results Including 17 articles and 1107 breast cancer patients.Meta-analysis results showed that Xiaoyaosan plus or minus prescription unite chemotherapy for treating breast cancer compared with chemotherapy for treating breast cancer, in breast cancer solid tumor short-term efficacy rate [OR=1.74,95%CI(1.27,2.39), P=0.0006], improve the quality of life of patients [OR=3.75,95%CI(2.58,5.44), P<0.00001],and syndrome improvement rate[OR=3.69,95%CI(1.43,9.49), P=0.007], relieve depression in patients [MD=-11.30,95%CI(15.66,6.94), P<0.00001)],reduce the bone marrow suppression(leukocyte decline, platelet decline) respectively was[OR=0.32,95%CI(0.20,0.51), P<0.00001] and [OR=0.37,95%CI(0.20, 0.67), P=0.001], reduce patients’ nausea and vomiting [OR=0.29,95% CI(0.17,0.48),P<0.00001],reduce patients the incidence of cardiotoxicity [OR=0.15,95%CI(0.06,0.37),P<0.0001]. However, there is insufficient evidence for reducing patients liver and kidney function injury [OR=0.59,95%CI(0.29,1.21), P=0.15], and for improving 3-year survival rate of advanced breast cancer [OR=2.11,95%CI(0.75,5.97), P>0.05].The reason is that there are too few included research data, only 4 studies and 2 studies respectively, and the quality of literature is different. Therefore, more samples should be taken in future studies to conduct big data series studies.Conclusion Xiaoyaosan combination chemotherapy for breast cancer can improve the breast cancer solid tumor short-term efficacy rate, and improve the quality of life of patients, and clinical syndrome;reduce depressive symptoms, and bone marrow suppression(leukocyte decline, platelet decline), and nausea and vomiting, and the incidence of cardiotoxicity. However, in terms of reducing liver and kidney function injury and improving 3-year survival rate of advanced breast cancer, evidence is insufficient, and need more studies.