title: Evidence that naturopathic therapy including Cordyceps sinensis prolongs survival of patients with hepatocellular carcinoma.
abstract: OBJECTIVE
  Naturopathic treatment will benefit patients with hepatocellular carcinoma (HCC).
  
  
  METHODS
  Retrospective analysis of case series of HCC patients treated with naturopathic agents.
  
  
  METHODS
  HCC was diagnosed by dynamic computed tomography (CT) imaging and α-fetoprotein (AFP) or PIVKA II, or by histology. Tumor staging was determined by CT. A modified Childs-Pugh scoring was used to assess liver disease. Patients were treated with orally administered combinations of 12 naturopathic agents. Patients were monitored clinically and by CT tumor imaging, serial tumor markers, and liver function tests.
  
  
  RESULTS
  
  
  
  METHODS
  101 patients with HCC (67 men and 34 women, age 67.2 ± 8.8 years) were treated for a median of 13.4 months (range 0.8-100.8). Of these 84% had cirrhosis, 63% had hepatitis C virus, 18% had hepatitis B virus, 1% had both, and 9% had metastatic disease. Median modified Childs-Pugh score was 6 (range 3-13). Barcelona Clinic Liver Cancer tumor stages of 0, A, B, C, and D were found in 36%, 25%, 20%, 14%, and 6%, respectively. Median AFP was 40 (range 0-311,000). Median PIVKA II was 59 (0-378,000). Previous treatment was included none (27%), resection with relapse (20%), transarterial chemoembolization (50%), radiofrequency ablation (28%), percutaneous ethanol injection therapy (15%), chemotherapy (14%).
  
  
  RESULTS
  Initial treatment was with 2.6 ± 0.8 agents (range 2-4). Overall, patients were treated with 3.7 ± 1.2 agents (range 2-7). There was a significant correlation between number of agents administered and survival (P < .0001). Patients treated with ≥4 agents survived significantly longer than patients treated with ≤3 agents (40.2 vs 6.4 months, P < .0001). This difference could not be attributed to statistically significant differences in severity of liver disease or tumor stage, delay in treatment, previous treatment, concurrent nondrug treatment, or censoring effects. The greatest effect was seen in patients treated with at least 4 agents that included Cordyceps sinensis. This prolonged survival was without toxic side effects and appeared to potentiate the survival benefit of conventional therapy.
  
  
  CONCLUSIONS
  Treatment of HCC with a regimen of ≥4 agents prepared from natural products was associated with prolonged survival in a substantial portion of patients. The data provide level II evidence for the efficacy of naturopathic therapy in HCC.
authors.affiliation: Niwa Institute for Immunology and Tosashimizu Hospital, Tosashimizu, Japan. yniwa@lime.ocn.ne.jp
authors.forename: Yukie
authors.initials: Y
authors.lastname: Niwa
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Matsuura
authors.forename: Masato
authors.initials: M
authors.lastname: Murakami
authors.forename: Junichi
authors.initials: J
authors.lastname: Sato
authors.forename: Keiichi
authors.initials: K
authors.lastname: Hirai
authors.forename: Hajime
authors.initials: H
authors.lastname: Sumi
mesh_terms: D000284:Administration, Oral; D000368:Aged; D001688:Biological Products / Q000008:administration & dosage / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000378:metabolism; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy* / Q000473:pathology / Q000628:therapy; D032661:Cordyceps / Q000737:chemistry*; D005260:Female; D006801:Humans; D008107:Liver Diseases / Q000188:drug therapy / Q000473:pathology; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010936:Plant Extracts / Q000008:administration & dosage / Q000627:therapeutic use; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate
chemical_list: D001688:Biological Products; D014408:Biomarkers, Tumor; D010936:Plant Extracts