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. 2021 Sep 6:12:739673.
doi: 10.3389/fphar.2021.739673. eCollection 2021.

A Multidimensional Bayesian Network Meta-Analysis of Chinese Herbal Injections for Treating Non-small Cell Lung Cancer With Gemcitabine and Cisplatin

Mengwei Ni  1 , Zhishan Wu  1 , Haojia Wang  1 , Wei Zhou  1 , Chao Wu  1 , Antony Stalin  2 , Changgeng Fu  3 , Peizhi Ye  4 , Shan Lu  1 , Yingying Tan  1 , Zhihong Huang  1 , Xiaotian Fan  1 , Jingyuan Zhang  1 , Xiaomeng Zhang  1 , Miaomiao Wang  1 , Jiarui Wu  1
Affiliations

A Multidimensional Bayesian Network Meta-Analysis of Chinese Herbal Injections for Treating Non-small Cell Lung Cancer With Gemcitabine and Cisplatin

Mengwei Ni et al. Front Pharmacol. .

Abstract

Introduction: As non-small cell lung cancer (NSCLC) seriously threatens human health, several clinical studies have reported that Chinese herbal injections (CHIs) in combination with and gemcitabine plus cisplatin (GP) are beneficial. This multidimensional network meta-analysis aimed to compare the clinical efficacy and safety of different CHIs in combination with GP against NSCLC. Methods: Randomized controlled trials (RCTs) for the treatment of NSCLC were retrieved from seven electronic databases from inception to April 30, 2020. Study selection and data extraction were based on a priori criteria. Data analysis was performed using Stata 13.0, WinBUGS 14.0 software. Multidimensional cluster analysis was performed using the "scatterplot3d" package in R 3.6.1 software. Results: This network meta-analysis included 71 eligible RCTs and 10 Chinese herbal injections. Delisheng injection and Kangai injection had the highest probability in terms of clinical effectiveness rate (94.60%) and gastrointestinal reactions (82.62%) when combined with GP compared with the other interventions. Compound Kushen injection combined with GP ranked ahead of the other interventions in terms of performance status (73.36%) and abnormal liver function (87.17%). Shenmai injection combined with GP had the highest probability in terms of leukopenia (94.59%) and thrombocytopenia (99.18%). Conclusion: The current evidence revealed that CHIs combined with GP have a better impact on patients with NSCLC than GP alone. Aidi injection, Compound kushen injection, and Kanglaite injection deserve more attention of clinicians when combined with GP in patients with NSCLC. Additionally, due to the limitations of this network meta-analysis, further well-designed, large-sample, multicenter RCTs are required to support our findings adequately.

Keywords: chinese herbal injections; gemcitabine plus cisplatin; multidimensional cluster; network meta-analysis; non-small cell lung cancer.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Graphical abstract of the network meta-analysis. Note: GP, gemcitabine plus cisplatin; SUCRA, surface under the cumulative ranking curve; OR, odds ratio.
FIGURE 2
FIGURE 2
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 3
FIGURE 3
Network graph for different outcomes. (A) Clinical effectiveness rate; (B) Performance status; (C) Leukopenia; (D) Gastrointestinal reactions; (E) Thrombocytopenia; and (F) Abnormal liver function. Note: ADI, Aidi injection; CKSI, Compound Kushen injection; DLSI, Delisheng injection; GP, Gemcitabine plus Cisplatin; JOEI, Javanica oil emulsion injection; KAI, Kangai injection; KLTI, Kanglaite injection; SMI, Shenmai injection; SQFZI, Shenqifuzheng injection; and XAPI, Xiaoaiping injection.
FIGURE 4
FIGURE 4
Assessment of risk bias.
FIGURE 5
FIGURE 5
Surface under the cumulative ranking curves for outcomes. (A) Clinical effectiveness rate; (B) Performance status; (C) Leukopenia; (D) Gastrointestinal reactions; (E) Thrombocytopenia; and (F) Abnormal liver function. Note: ADI, Aidi injection; CKSI, Compound Kushen injection; DLSI, Delisheng injection; GP, Gemcitabine plus Cisplatin; JOEI, Javanica oil emulsion injection; KAI, Kangai injection; KLTI, Kanglaite injection; SMI, Shenmai injection; SQFZI, Shenqifuzheng injection; and XAPI, Xiaoaiping injection.
FIGURE 6
FIGURE 6
Cluster analysis plots for six outcomes. (A) Clinical effectiveness rate (x-axis) and performance status (y-axis); (B) Leukopenia (x-axis) and gastrointestinal reactions (y-axis); (C) Clinical effectiveness rate (x-axis), performance status (y-axis), and leukopenia (z-axis); (D) Clinical effectiveness rate (x-axis), performance status (y-axis), and gastrointestinal reactions (z-axis); (E) Performance status (x-axis), clinical effectiveness rate (y-axis), and thrombocytopenia (z-axis); (F) Performance status (x-axis), clinical effectiveness rate (y-axis), and abnormal liver function (z-axis). Note: Interventions with the same color belong to the same cluster, and interventions located in the upper-right corner indicate optimal therapy for two different outcomes. ADI, Aidi injection; CKSI, Compound Kushen injection; DLSI, Delisheng injection; GP, Gemcitabine plus Cisplatin; JOEI, Javanica oil emulsion injection; KAI, Kangai injection; KLTI, Kanglaite injection; SMI, Shenmai injection; SQFZI, Shenqifuzheng injection; and XAPI, Xiaoaiping injection.
FIGURE 7
FIGURE 7
Comparison-adjusted funnel plot for outcomes. (A) clinical effectiveness rate; (B) performance status. Note: ADI, Aidi injection; CKSI, Compound Kushen injection; DLSI, Delisheng injection; GP, Gemcitabine plus Cisplatin; JOEI, Javanica oil emulsion injection; KAI, Kangai injection; KLTI, Kanglaite injection; SMI, Shenmai injection; SQFZI, Shenqifuzheng injection; and XAPI, Xiaoaiping injection.
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