title: Traditional Chinese Medicines in the treatment of hepatocellular cancers: a systematic review and meta-analysis.
abstract: BACKGROUND
  Liver cancer is a common malignancy with a high mortality rate. Given the poor prognosis associated with this cancer, many patients seek additional therapies that may improve quality of life or survival. Several Traditional Chinese Medicines (TCM) have been evaluated in clinical trials, but little is known about them outside of China.
  
  
  METHODS
  We searched independently and in duplicate 8 electronic databases, including 2 Chinese language databases, until February 2009. We included any randomized clinical trials (RCT) evaluating a TCM oral preparation for the treatment of hepatocellular cancers. We abstracted data on survival, tumor response, and performance scores. We conducted a random-effects meta-analysis and applied a meta-regression analysis.
  
  
  RESULTS
  We included 45 RCTs (n = 3,236). All studies employed an active control group. In general, the reporting of methodological issues was poor. We analyzed data from 37 trials reporting 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 treatment effect (OR 1.34, 95% CI, 1.04-1.71, P = 0.01) than the pooled broad estimate, also the case for astragalus-based treatments (OR 1.35, 95% CI, 1.001-1.80. P = 0.048). We examined survival rates and 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 (22 trials, 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).
  
  
  CONCLUSIONS
  All included trials were conducted in China where emerging evidence suggests many RCTs are not, in fact, randomized. Publication bias may exist, favouring positive reports.
  
  
  CONCLUSIONS
  Our meta-analysis displays compelling evidence of effectiveness for hepatocellular cancers that should be evaluated in high-quality and transparent clinical trials.
authors.affiliation: Shanghai Hospital #4, Shanghai, PR China. pwu@ccnm.edu
authors.forename: Ping
authors.initials: P
authors.lastname: Wu
authors.forename: Jean Jacques
authors.initials: JJ
authors.lastname: Dugoua
authors.forename: Oghenowede
authors.initials: O
authors.lastname: Eyawo
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Mills
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000188:drug therapy*; D002681:China; D003131:Combined Modality Therapy; D004365:Drugs, Chinese Herbal / Q000627:therapeutic use*; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy*; D008516:Medicine, Chinese Traditional; D008517:Phytotherapy
chemical_list: D004365:Drugs, Chinese Herbal
references.citation: Cancer Causes Control. 2000 Jul;11(6):565-76
references.pmid: 10880039
references.citation: Life Sci. 2003 Sep 12;73(17):2249-62
references.pmid: 12927594
references.citation: Planta Med. 1998 Apr;64(3):220-4
references.pmid: 9581518
references.citation: Am J Public Health. 2002 Oct;92(10):1619-28
references.pmid: 12356611
references.citation: Planta Med. 2002 Mar;68(3):204-8
references.pmid: 11914954
references.citation: J Clin Lab Immunol. 1988 Aug;26(4):183-7
references.pmid: 3264344
references.citation: J Clin Oncol. 2006 Jan 20;24(3):419-30
references.pmid: 16421421
references.citation: Expert Opin Investig Drugs. 2009 May;18(5):617-35
references.pmid: 19388879
references.citation: Cancer Lett. 2000 Mar 13;150(1):41-8
references.pmid: 10755385
references.citation: BMJ. 1998 Nov 7;317(7168):1318
references.pmid: 9804732
references.citation: Jpn J Cancer Res. 1994 Jun;85(6):645-51
references.pmid: 8063619
references.citation: Stat Methods Med Res. 1993;2(2):121-45
references.pmid: 8261254
references.citation: Biochem Biophys Res Commun. 2004 Aug 6;320(4):1103-11
references.pmid: 15249203
references.citation: Ann Oncol. 2008 May;19 Suppl 2:ii27-8
references.pmid: 18456757
references.citation: Stat Med. 2002 Jun 15;21(11):1539-58
references.pmid: 12111919
references.citation: J Clin Lab Immunol. 1988 Mar;25(3):119-23
references.pmid: 3260960
references.citation: Control Clin Trials. 1998 Apr;19(2):159-66
references.pmid: 9551280
references.citation: Zhongguo Zhong Xi Yi Jie He Za Zhi. 1998 Jul;18(7):411-3
references.pmid: 11477817
references.citation: Immunol Invest. 1999 Sep-Dec;28(5-6):291-303
references.pmid: 10574627
references.citation: Integr Cancer Ther. 2005 Sep;4(3):219-29
references.pmid: 16113029
references.citation: World J Gastroenterol. 2009 Mar 21;15(11):1301-14
references.pmid: 19294759
references.citation: Contemp Clin Trials. 2008 Sep;29(5):727-31
references.pmid: 18579449
references.citation: Am J Public Health Nations Health. 1966 Oct;56(10):1745-50
references.pmid: 5951494
references.citation: Zhongguo Zhong Xi Yi Jie He Za Zhi. 2005 Jan;25(1):8-11
references.pmid: 15719740
references.citation: Trials. 2009 Jul 02;10:46
references.pmid: 19573242
references.citation: J Biol Response Mod. 1983;2(3):227-37
references.pmid: 6644339
references.citation: Clin Infect Dis. 1999 Mar;28(3):597-601
references.pmid: 10194084
references.citation: J Clin Lab Immunol. 1988 Mar;25(3):125-9
references.pmid: 3260961
references.citation: Lancet. 2008 Dec 6;372(9654):1938-40
references.pmid: 18930523
references.citation: Gastroenterology. 2004 Nov;127(5 Suppl 1):S5-S16
references.pmid: 15508102
references.citation: J Nat Prod. 2001 Sep;64(9):1148-52
references.pmid: 11575946