Investigation on the Efficiency of Chinese Herbal Injections combined with Concurrent Chemoradiotherapy for Treating Nasopharyngeal Carcinoma based on Multidimensional Bayesian Network Meta-analysis

Abstract

Introduction: Given the wide utilization of Chinese herbal injections in the treatment of nasopharyngeal carcinoma (NPC), this network meta-analysis (NMA) was devised to compare the clinical efficacy and safety of different Chinese herbal injections combined with concurrent chemoradiotherapy (CCRT) against NPC. Methods: Randomized controlled trials (RCTs) were retrieved from seven electronic databases from the date of database establishment to October 5, 2020. Study selection and data extraction conformed to a priori criteria. Focusing on clinical effective rate, performance status, grade ≥3 oral mucositis, nausea and vomiting, leukopenia, and thrombopenia, this NMA was performed with Review Manager 5.3.5, Stata 13.1, WinBUGS 1.4.3, and R 4.0.3 software. Results: Ten inventions from 37 RCTs involving 2,581 participants with NPC that evaluated the clinical effective rate, nausea and vomiting, leukopenia, thrombopenia, and grade ≥3 oral mucositis were included. Compared with CCRT alone, Elemene injection and Compound Kushen injection were associated with significantly improved clinical effective rates, and Elemene injection plus CCRT had the highest probability in terms of clinical effective rate (78.07%) compared with the other interventions. Shenqifuzheng injection, Xiaoaiping injection, and Shenmai injection ranked the best in terms of performance status (79.02%), nausea and vomiting (86.35%), and grade ≥3 oral mucositis (78.14%) when combined with CCRT. Kangai injection combined with CCRT ranked ahead of the other injections in terms of leukopenia (90.80%) and thrombopenia (91.04%), and had a better impact on improving performance status and reducing leukopenia, thrombopenia, grade ≥3 oral mucositis, and nausea and vomiting in the multidimensional cluster analysis. Conclusion: Current clinical evidence indicates that Elemene injection combined with CCRT has the best clinical effective rate and that Kangai injection might have a comprehensively better impact on improving performance status and reducing adverse reactions against NPC. Additionally, due to the limitations of this NMA, more multicenter, high-quality, and head-to-head RCTs are needed to properly support our findings.

Keywords: Bayesian model; Chinese herbal injections; multidimensional cluster; nasopharyngeal carcinoma; network meta-analysis.

FIGURE 1

Flow chart of the search for eligible studies. Note: (n, number of articles. CNKI, China National Knowledge Infrastructure; WanFang, the WanFang Database; VIP, the Chinese Scientific Journals Full-Text Database; and SinoMed, the Chinese Biomedical Literature Database).

FIGURE 2

Network graph for different outcomes. (A) Clinical effective rate, (B) performance status, (C) leukopenia, (D) thrombopenia, (E) nausea and vomiting, and (F) grade ≥3 oral mucositis. Note: (CCRT, concurrent chemoradiotherapy; AD, Aidi injection; CKS, Compound Kushen injection; EL, Elemene injection; KA, Kangai injection; KLT, Kanglaite injection; SM1, Shengmai injection; SQFZ, Shenqqifuzheng injection; SM2, Shenmai injection; and XAP, Xiaoaiping injection).

FIGURE 3

Assessment of risk bias.

FIGURE 4

Rank probabilities and SUCRA for different outcomes. (A) The rank probability of clinical effective rate, (B) SUCRA of performance status, (C) SUCRA of leukopenia, (D) SUCRA of thrombopenia, (E) SUCRA of nausea and vomiting, and (F) SUCRA of grade ≥3 oral mucositis. Note: (AD, Aidi injection; CCRT, concurrent chemoradiotherapy; CKS, Compound Kushen injection; EL, Elemene injection; KA, Kangai injection; KLT, Kanglaite injection; SM1, Shengmai injection; SQFZ, Shenqifuzheng injection; SM2, Shenmai injection; and XAP, Xiaoaiping injection).

FIGURE 5

Cluster analysis plots for six outcomes. (A) Clinical effective rate (x-axis) and leukopenia (y-axis), (B) leukopenia and nausea and vomiting (y-axis), (C) clinical effective rate (x-axis), nausea and vomiting (y-axis), and leukopenia (z-axis), (D) performance status (x-axis), oral mucositis (y-axis), and leukopenia (z-axis), (E) leukopenia (x-axis), nausea and vomiting (y-axis), and thrombopenia (z-axis), (F) leukopenia (x-axis), oral mucositis (y-axis), and nausea and vomiting (z-axis). Note: (AD, Aidi injection; CCRT, concurrent chemoradiotherapy; CKS, Compound Kushen injection; EL, Elemene injection; KA, Kangai injection; KLT, Kanglaite injection; SM1, Shengmai injection; SQFZ, Shenqifuzheng injection; SM2, Shenmai injection; and XAP, Xiaoaiping injection).

FIGURE 6

Funnel plots of clinical effective rate. Note: (AD, Aidi injection; CCRT, concurrent chemoradiotherapy; CKS, Compound Kushen injection; EL, Elemene injection; KA, Kangai injection; KLT, Kanglaite injection; SM1, Shengmai injection; SQFZ, Shenqifuzheng injection; SM2, Shenmai injection; and XAP, Xiaoaiping injection).