Traditional Chinese Medicines In The Treatment of Hepatocellular Cancers: A Systematic Review and Meta-Analysis

Background:Liver cancer is a common malignancy with a high mortality rate. Given the poorprognosis associated with this cancer, many patients seek additional therapies that may improvequality of life or survival. Several Traditional Chinese Medicines (TCM) have been evaluated inclinical trials, but little is known about them outside of China.Methods:We searched independently and in duplicate 8 electronic databases, including 2 Chineselanguage databases, until February 2009. We included any randomized clinical trials (RCT)evaluating a TCM oral preparation for the treatment of hepatocellular cancers. We abstracted dataon survival, tumor response, and performance scores. We conducted a random-effects metaanalysisand applied a meta-regression analysis.Results:We included 45 RCTs (n = 3,236). All studies employed an active control group. Ingeneral, the reporting of methodological issues was poor. We analyzed data from 37 trialsreporting on complete response effects score (Relative Risk [RR] of 1.26 (95 CI, 1.04–1.52, P =0.01, I2 = 0%, P = 0.99). Products containing ginseng, astragalus and mylabris had a larger treatmenteffect (OR 1.34, 95% CI, 1.04–1.71, P = 0.01) than the pooled broad estimate, also the case forastragalus-based treatments (OR 1.35, 95% CI, 1.001–1.80. P = 0.048). We examined survival ratesand pooled 15 studies reporting on 6 month outcomes (RR 1.10, 95% CI, 1.04–1.15, P = < 0.0001,I2 = 0%, P = 0.60). This effect was consistent at other prospective dates, including 12 months (22trials, RR 1.26, 95% CI, 1.17–1.36, P = < 0.0001, I2 = 7%, P = 0.36), 24 months (15 trials, 1.72, 95%CI, 1.40–2.03, P = < 0.0001, I2 = 0%, P = 0.75); and, at 36 months (8 trials, RR 2.40, 95% CI, 1.65–3.49, P = < 0.0001, I2 = 0%, P = 0.62).Limitations:All included trials were conducted in China where emerging evidence suggests manyRCTs are not, in fact, randomized. Publication bias may exist, favouring positive reports.Conclusion:Our meta-analysis displays compelling evidence of effectiveness for hepatocellularcancers that should be evaluated in high-quality and transparent clinical trials.