Comparative efficacy of various CHIs combined with western medicine for non-small cell lung cancer: A bayesian network meta-analysis of randomized controlled trials

Abstract

Background: Given the limitations of Western medicine (WM) for the treatment of non-small cell lung cancer (NSCLC) and the wide exploration of Chinese herbal injections (CHIs), systematically evaluate the efficacy of Various CHIs Combined with WM for Non-small Cell Lung Cancer. In this study, we performed a network meta-analysis to evaluate the comparative efficacy of 16 CHIs combined with WM regimens for the treatment of NSCLC. Methods: Literature databases were searched from their inception to November 2021, and all randomized control trials (RCTs) involving NSCLC patients treated with a combination of Chinese and WM were retrieved. Outcomes, including disease control rate, survival quality score, incidence of gastrointestinal adverse reactions, incidence of leukopenia, and incidence of thrombocytopenia, were analyzed using RevMan (5.3), Stata17, and R software. Surface under the cumulative ranking curve (SUCRA) probability values were calculated to rank the treatments examined, and clustering analysis was used to compare the effects of CHIs on different outcomes. Results: A total of 389 studies involving 31,263 patients and 16 CHIs were included. The 16 CHIs were: Aidi injection (ADI), Huachansu injection (HCSI), oil of Ophiopogon injection (OOMI), disodium cantharidinate and vitamin B6 injection (DCI), Shenfu injection (SFI), Shenmai injection (SMI), Shenqi Fuzheng injection (SQFZI), Chansu injection (CSI), Delisheng injection (DLSI), Fufang Kushen injection (FFKSI), Huangqi injection (HQI), Kangai injection (KAI), Kanglaite injection (KLTI), Shengmai injection (SI), Xiangguduotang injection (XGDTI), and Xiaoaiping injection (XAPI). The results of the network meta-analysis showed that, with WM treatment as a co-intervention, CSI was most likely to improve the disease control rate (SUCRA = 80.90%), HQI had the highest probability of being the best option for improving the survival quality score (SUCRA = 82.60%), DCI had the highest probability of reducing the incidence of gastrointestinal adverse reactions (SUCRA = 85.50%), HCSI + WM had the highest probability of reducing the incidence of thrombocytopenia (SUCRA = 91.30%), while SMI had the highest probability of reducing the incidence of leukopenia (SUCRA = 79.10%). Conclusion: CHIs combined with WM is proved to be more effective than WM alone, which may be beneficial to NSCLC patients. SMI + WM and DCI + WM are most likely the optimal CHI to improve disease control rates, survival quality score, and reduce adverse effects. This study has limitations; therefore, higher quality RCTs and real-world evidence are required to support our conclusions.

Keywords: Chinese herbal injections; Chinese medicine; bayesian model; combined therapy; network meta-analysis; non-small cell lung cancer.

FIGURE 1

PRISMA flow diagram.

FIGURE 2

Assessment of risk of bias.

FIGURE 3

Network graphs for different outcomes. (A) Disease control rate. (B) Survival quality score. (C) Incidence of gastrointestinal adverse reactions. (D) Incidence of leukopenia. (E) Incidence of thrombocytopenia.

FIGURE 4

Surface under the cumulative ranking curve area plots for each outcome analyzed (The larger the area under the curve, the higher the ranking and the higher the probability that the CHIs are the best interventions). (A) Disease control rate. (B) Survival quality score. (C) Incidence of gastrointestinal adverse reactions. (D) Incidence of leukopenia. (E) Incidence of thrombocytopenia.

FIGURE 5

Cluster analysis plots for outcomes. Cluster analysis plot of: (A) disease control rate (DCR) and survival quality score, (B) DCR and incidence of gastrointestinal adverse reactions, (C) DCR and incidence of leukopenia, (D) DCR and incidence of thrombocytopenia, (E) survival quality score and incidence of gastrointestinal adverse reactions, (F) survival quality score and incidence of leukopenia, and (G) survival quality score and incidence of thrombocytopenia. Interventions located in the upper right corner indicate optimal therapies for two different outcomes, as follows: A, adi + wm; B, csi + wm; C, dci + wm; D, dlsi + wm; E, flksi + wm; F, hcsi + wm; G, hqi + wm; H, kai + wm; I, klti + wm; J, oomi + wm; K, sfi4-wm; L, si + wtn; M, smi + win; N, sqfzi + wm; 0, wm; P, xapi + wm; Q, xgdti + wm.

FIGURE 6

Funnel plots (A comparison-adjusted funnel plot was used to assess potential publication bias. If points on both sides of the midline in the funnel diagram were symmetric, which meant the comection guideline was at right angles to the midline, it was considered indicative of no significant publication bias). (A) Disease control rate. (B) Survival quality score. (C) Incidence of gastrointestinal adverse reactions. (D) Incidence of leukopenia. (E) Incidence of thrombocytopenia. A, adi + wm; B, csi + wm; C, dci + wm; D, dlsi + wm; E, fflcsi + wm; F, hcsi + wm; G, hqi + wm; H, kai + wm; I, klti + wm; J, oomi + wm; K, sfi + wm; L, si + wm; M, smi + wm; N, sqfzi + wm; 0, win; P, xapi + wm; Q, xgdti + wm.