Astragalus-based Chinese herbs and platinum-based chemotherapy for advanced non-small-cell lung cancer:: Meta-analysis of randomized trials
Astragalus-based Chinese herbs and platinum-based chemotherapy for advanced non-small-cell lung cancer:: Meta-analysis of randomized trials
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DOI：
10.1200/jco.2005.03.6392
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发表时间：
2006-01-20
影响因子：
45.3
通讯作者：
Colford, JM
中科院分区：
文献类型：
--
作者：
McCulloch, M;See, C;Colford, JM
目的全身治疗晚期非小细胞肺癌疗效低、毒性大。据报道，一些中草药可以提高化疗疗效，降低毒性。特别是，黄芪已被证明具有刺激巨噬细胞和自然杀伤细胞活性以及抑制t辅助细胞2型细胞因子的免疫益处。许多已发表的研究评估了黄芪和其他中草药与化疗联合使用的效果。我们试图评估随机试验的证据，以黄芪为基础的中草药联合以铂为基础的化疗（与单独以铂为基础的化疗相比）可改善生存，增加肿瘤反应，改善表现状态或降低化疗毒性。方法检索CBM、MEDLINE、TCMLARS、EMBASE、Cochrane Library和CCRCT数据库中所有语言的研究。我们将使用相同草药组合的研究分组进行随机效应荟萃分析。结果在1305篇可能相关的出版物中，34项随机研究代表2815名患者符合纳入标准。12项研究（n = 940例患者）报告12个月时死亡风险降低（风险比[RR] = 0.67, 95% CI, 0.52 ~ 0.87）。30项研究（n = 2,472）报告了改善的肿瘤反应数据（RR = 1,34; 95% CI， 1.24至1.46）。在亚组分析中，两项研究（n = 221例患者）中，金复康降低了24个月时的死亡风险（RR = 0.58; 95% CI， 0.49至0.68），三项研究（n = 411）中，金复康提高了肿瘤反应（RR = 1.76; 95% CI， 1.23至2.53）。Ai Di注射液（4项研究；n 257）稳定或改善Karnofsky性能状态（RR = 1.28; 95% Cl, 1.12 ~ 1.46）。结论黄芪类中药联合化疗可提高铂类化疗的疗效。这些结果需要通过严格控制的试验来证实。
Purpose Systemic treatments for advanced non-small-cell lung cancer have low efficacy and high toxicity. Some Chinese herbal medicines have been reported to increase chemotherapy efficacy and reduce toxicity. In particular, Astragalus has been shown to have immunologic benefits by stimulating macrophage and natural killer cell activity and inhibiting T-helper cell type 2 cytokines. Many published studies have assessed the use of Astragalus and other Chinese herbal medicines in combination with chemotherapy. We sought to evaluate evidence from randomized trials that Astragalus-based Chinese herbal medicine combined with platinum-based chemotherapy (versus platinum-based chemotherapy alone) improves survival, increases tumor response, improves performance status, or reduces chemotherapy toxicity.Methods We searched CBM, MEDLINE, TCMLARS, EMBASE, Cochrane Library, and CCRCT databases for studies in any language. We grouped studies using the same herbal combinations for random-effects meta-analysis.Results Of 1,305 potentially relevant publications, 34 randomized studies representing 2,815 patients met inclusion criteria. Twelve studies (n = 940 patients) reported reduced risk of death at 12 months (risk ratio [RR] = 0.67, 95% CI, 0.52 to 0.87). Thirty studies (n = 2,472) reported improved tumor response data (RR = 1,34; 95% CI, 1.24 to 1.46). In subgroup analyses, Jin Fu Kang in two studies (n = 221 patients) reduced risk of death at 24 months (RR = 0.58; 95% CI, 0.49 to 0.68) and in three studies (n = 411) increased tumor response (RR = 1.76; 95% CI, 1.23 to 2.53). Ai Di injection (four studies; n 257) stabilized or improved Karnofsky performance status (RR = 1.28; 95% Cl, 1.12 to 1.46).Conclusion Astragalus-based Chinese herbal medicine may increase effectiveness of platinum-based chemotherapy when combined with chemotherapy. These results require confirmation with rigorously controlled trials.