Chinese Medicine as an Adjunctive Treatment for Gastric Cancer: Methodological Investigation of meta-Analyses and Evidence Map

Abstract

Background: Many meta-analyses (MAs) on Chinese medicine (CM) as an adjunctive treatment for gastric cancer have been published in recent years. However, the pooled evidence reported in MAs and their methodological quality remain unknown. Therefore, we designed a study to comprehensively evaluate and summarize the current evidence of CMs for gastric cancer in published MAs.Methods: A systematic search on MAs published in English from inception to 1st September 2021 was conducted in PubMed and Embase. The AMSTAR-2 tool was used to evaluate the methodological quality of the included MAs, and the results of the quality assessment were visualized using the evidence mapping method. Stata 17/SE was used for statistical analysis (Registration number: INPLASY202190005).Results: A total of 20 MAs (16 pairwise and 4 network MAs) were included from 118 records. These MAs were published in 14 journals from 2013 to 2021, with the number of patients and trials ranging from 688 to 6,857, and from 10 to 85, respectively. A large number of CMs (e.g., AiDi, FuFangKuShen, and HuaChanSu) in combination with chemotherapy for gastric cancer were identified among the included MAs. According to the pooled results reported in MAs, when compared to chemotherapy alone, CMs in combination with chemotherapy not only improve various outcomes on efficacy (e.g., objective response rate, quality of life) but also reduce various adverse reactions (e.g., leucopenia, nausea and vomiting). Only 2 MAs were low in terms of the overall methodological quality, while the other 18 MAs were all critically low. The methodology was required to be advanced significantly, mainly involving: study protocol and registration, explanation for the inclusion of study design, list of excluded studies with justifications, adequate details of included studies, reporting on funding sources of primary studies, and evaluation of the potential impact of risk of bias. In addition, MAs that received funds support (β = 2.68; 95%CI: 0.40 to 4.96; p = 0.024) or were published in journals with higher impact factor (β = 2.81; 95%CI: 0.69 to 4.92; p = 0.012) had a higher score on the overall methodological quality in the univariate analysis, but the results were not statistically significant according to the multivariate analysis.Conclusion: Combining CMs with chemotherapy can potentially improve clinical outcomes and reduce the relevant adverse effects in patients with gastric cancer. However, the methodological quality of relevant MAs requires significant improvement, and the current evidence needs to be validated through multinational trials that are well-designed and have a large sample size.

Clinical Efficacy of Modified Yiwei Shengyang Decoction Combined with FOLFOX4 Chemotherapy Regimen in the Treatment of Advanced Gastric Cancer and Its Effect on Tumor Marker Levels

“…Pinellia dries dampness, resolves phlegm, reduces inversion, relieves vomiting, and mitigates swelling. Atractylodes rhizoma has the functions of invigorating the spleen and nourishing qi, drying dampness and diuretic water, antiperspirant, tocolysis, and releasing heat [ 18 ].…”

Kanglaite (Coix Seed Extract) as Adjunctive Therapy in Cancer: Evidence Mapping Overview Based on Systematic Reviews With Meta-Analyses

“…The present study is an overview of published systematic reviews with meta-analyses focusing on the use of KLT in treating cancers or complications of cancers. This study was completed by referring to our previous publication (Lu et al, 2021a) and relevant methodological paper (Pollock et al, 2017), and presented based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines (Page et al, 2021) (Supplementary Table S1).…”

“…Cancer adversely influences the health and quality of life of affected individuals, and cancer deaths account for 17% of all deaths worldwide (Wei et al, 2022). Although chemotherapy is currently the primary intervention for most common cancers such as those of the lungs, stomach, and liver, serious adverse reactions and multidrug resistance limit the use and efficacy of chemotherapy in clinical practice (Lu et al, 2021a;Wei et al, 2022). Traditional Chinese medicine, usually regarded as a type of complementary and alternative medicine, shows promise in providing a supplementary therapeutic pathway for medical oncologists to assist patients with cancer (Wang et al, 2020a;Liu et al, 2020).…”

“…This approach is now popular with evidence-based healthcare practitioners and health policy makers, as shown by the fact that this type of evidence has been rapidly increasing in the past years (Bougioukas et al, 2021). Moreover, evidence mapping is a novel method to present evidence directly through visualization and, in turn, has been widely used in overviews (Lu et al, 2021a;Lu et al, 2021b). For instance, in the latest study (Lu et al, 2021a) by our team, an overview with evidence map was conducted to summarize the evidence from meta-analyses of Chinese medicines to treat gastric cancer.…”

“…Moreover, evidence mapping is a novel method to present evidence directly through visualization and, in turn, has been widely used in overviews (Lu et al, 2021a;Lu et al, 2021b). For instance, in the latest study (Lu et al, 2021a) by our team, an overview with evidence map was conducted to summarize the evidence from meta-analyses of Chinese medicines to treat gastric cancer. Given the aforementioned research gap, this overview was designed to map the clinical evidence on KLT for cancers or conditions related to cancers that have been reported in published meta-analyses.…”