基于网状Meta分析和多准则决策分析3种活血消癥类口服中成药治疗原发性肝癌的效益风险评价

Benefit-risk assessment of three oral Chinese patent medicines for activating blood and eliminating mass in treating primary liver cancer based on network Meta-analysis and multi-criteria decision analysis

采用网状Meta分析和多准则决策分析(MCDA)模型,评估复方斑蝥胶囊、回生口服液和金龙胶囊治疗原发性肝癌的效益风险。检索中国知网(CNKI)、万方(Wanfang)、维普(VIP)、Web of Science、PubMed、Cochrane Library等数据库发表的复方斑蝥胶囊、回生口服液、金龙胶囊治疗原发性肝癌的随机对照试验(RCT)。采用R 4.2软件进行网状Meta分析,间接比较得出3种中成药的效应值。结合效益风险指标,应用MCDA模型建立价值树;应用Hiview 3.2软件计算3种中成药治疗原发性肝癌的效益值、风险值、效益风险值,并进行敏感性分析评价结果的稳健性;借助Oracle Crystal Ball 11.1软件运行蒙特卡洛模拟,优化评估结果。共纳入39篇RCTs。结果显示,复方斑蝥胶囊、回生口服液和金龙胶囊联合肝动脉化疗栓塞术(TACE)的效益值分别为45、51和45,风险值分别为59、47和41,效益风险值分别为52、49和43。复方斑蝥胶囊与回生口服液、复方斑蝥胶囊与金龙胶囊、回生口服液与金龙胶囊的效益风险差及[95%CI]分别为3.00[-13.09,21.82]、9.00[-4.39,24.62]、6.00[-8.84,20.28]。基于MCDA模型结果,回生口服液+TACE治疗原发性肝癌的效益最大,金龙胶囊+TACE治疗原发性肝癌的风险最大,复方斑蝥胶囊+TACE治疗原发性肝癌的整体获益最好。综合考虑疗效和安全性,3种口服中成药联合TACE治疗原发性肝癌的优先排序为复方斑蝥胶囊、回生口服液、金龙胶囊。

Network Meta-analysis and multi-criteria decision analysis(MCDA)model were performed to evaluate the benefit-risk of Compound Cantharis Capsules,Huisheng Oral Solution,and Jinlong Capsules in the adjuvant treatment of primary liver cancer(PLC).The randomized controlled trial(RCT)of Compound Cantharis Capsules,Huisheng Oral Solution,and Jinlong Capsules in treating PLC were retrieved from CNKI,Wanfang,VIP,Web of Science,PubMed,and Cochrane Library.R 4.2 was employed to conduct a network Meta-analysis,on the basis of which the effect values of the three medicines were obtained by indirect comparison.MCDA was performed to establish the value tree based on the benefit-risk indexes.Hiview 3.2 was used to calculate the benefit values,risk values,and benefit-risk values of the three medicines in treating PLC,and a sensitivity analysis was carried out to evaluate the robustness of the results.Oracle Crystal Ball 11.1 was employed to optimize the evaluation results by Monte Carlo simulation.A total of 39 RCTs were included.The results showed that Compound Cantharis Capsules,Huisheng Oral Solution,and Jinlong Capsules combined with transcatheter arterial chemoembolization(TACE)had the benefit values of 45,51 and 45,the risk values of 59,47,and 41,and the benefit-risk values of 52,49,and 43,respectively.The benefit-risk differences and[95%CI]of Compound Cantharis Capsules vs Huisheng Oral Solution,Compound Cantharis Capsules vs Jinlong Capsules,and Huisheng Oral Solution vs Jinlong Capsules were 3.00[-13.09,21.82],9.00[-4.39,24.62],and 6.00[-8.84,20.28],respectively.Based on the results of MCDA,Huisheng Oral Solution,Jinlong Capsules,and Compound Cantharis Capsules combined with TACE had the greatest benefit,the greatest risk,and the best overall benefit,respectively.Considering the efficacy and safety,the priority of the three oral Chinese patent medicines combined with TACE for treating PLC followed the trend of Compound Cantharis Capsules,Huisheng Oral Solution,and Jinlong Capsules.