title: The Therapeutic Efficacy and Safety of Compound Kushen Injection Combined with Transarterial Chemoembolization in Unresectable Hepatocellular Carcinoma: An Update Systematic Review and Meta-Analysis.
abstract: BACKGROUND
  Compound Kushen Injection (CKI) is a Chinese patent medicine approved by the China Food and Drug Administration for the treatment of various types of solid tumors. CKI, combined with transarterial chemoembolization (TACE), is believed to increase the therapeutic efficacy of unresectable hepatocellular carcinoma (HCC). We report an updated and extended meta-analysis with detailed outcomes of both the efficacy and adverse events (AEs) of CKI combined with TACE therapy.
  
  
  METHODS
  Electronic databases, including PubMed, Embase, the Cochrane Library, the Chinese Biomedical Database (CBM), Wanfang, the VIP medicine information system (VMIS) and the China National Knowledge Infrastructure (CNKI), were examined for relevant articles before November 13, 2015. An odds ratio (OR) was used to estimate tumor response (TR), Karnofsky Performance Scale (KPS) improvement, Child-Pugh (CP) improvement, survival rate (SR) and AEs. A publication bias and a subgroup analysis were also assessed.
  
  
  RESULTS
  Eighteen studies, with a total of 1,338 HCC patients who met the criteria for the meta-analysis, were included. TR, KPS improvement and CP improvement were significantly enhanced for the combination therapy compared to TACE alone (OR = 1.84, 95% CI: [1.46, 2.33], P < 0.00001; OR = 2.37, 95% CI: [1.76, 3.18], P < 0.00001; OR = 1.81, 95% CI: [1.08, 3.03], P = 0.02, respectively). The combination therapy was associated with an improvement in 1-year and 2-year SRs but not an improved 3-year SR (OR = 2.40; 95% CI: [1.59, 3.62], P < 0.0001; OR = 2.49, 95% CI: [1.24, 5.00], P = 0.01; OR = 2.49, 95% CI: [0.94, 6.61], P = 0.07, respectively). A safety analysis indicated that AEs (including nausea/vomiting, fever, hepatalgia, increased transaminase, increased bilirubin and leukopenia) were reduced for the combination treatment compared to TACE alone.
  
  
  CONCLUSIONS
  The combination treatment of TACE and CKI was associated with improved TR, KPS and CP improvement and improved 1- and 2-year SRs in patients with unresectable HCC. The 3-year SR was not improved. The combination therapy resulted in a reduction in AEs. The findings of this study should be interpreted with caution because of the small sample size and study limitations.
authors.affiliation: Department of Pharmacy, 302 Military Hospital of People's Liberation ArmyBeijing, China; Pharmacy College, Chengdu University of Traditional Chinese MedicineChengdu, China.
authors.forename: Xiao
authors.initials: X
authors.lastname: Ma
authors.affiliation: Research and Technology Service Center, 302 Military Hospital of People's Liberation Army Beijing, China.
authors.forename: Rui-Sheng
authors.initials: RS
authors.lastname: Li
authors.affiliation: Pharmacy College, Chengdu University of Traditional Chinese Medicine Chengdu, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Pharmacy, 302 Military Hospital of People's Liberation ArmyBeijing, China; Pharmacy College, Chengdu University of Traditional Chinese MedicineChengdu, China.
authors.forename: Yin-Qiu
authors.initials: YQ
authors.lastname: Huang
authors.affiliation: China Military Institute of Chinese Medicine, 302 Military Hospital of People's Liberation Army Beijing, China.
authors.forename: Peng-Yan
authors.initials: PY
authors.lastname: Li
authors.affiliation: Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University Chengdu, China.
authors.forename: Ji
authors.initials: J
authors.lastname: Wang
authors.affiliation: Liver Failure Treatment and Research Center, 302 Military Hospital of People's Liberation Army Beijing, China.
authors.forename: Hai-Bin
authors.initials: HB
authors.lastname: Su
authors.affiliation: Department of Integrative Medical Center, 302 Military Hospital of People's Liberation Army Beijing, China.
authors.forename: Rui-Lin
authors.initials: RL
authors.lastname: Wang
authors.affiliation: China Military Institute of Chinese Medicine, 302 Military Hospital of People's Liberation Army Beijing, China.
authors.forename: Ya-Ming
authors.initials: YM
authors.lastname: Zhang
authors.affiliation: Department of Integrative Medical Center, 302 Military Hospital of People's Liberation Army Beijing, China.
authors.forename: Hong-Hong
authors.initials: HH
authors.lastname: Liu
authors.affiliation: Pharmacy College, Chengdu University of Traditional Chinese MedicineChengdu, China; China Military Institute of Chinese Medicine, 302 Military Hospital of People's Liberation ArmyBeijing, China.
authors.forename: Cong-En
authors.initials: CE
authors.lastname: Zhang
authors.affiliation: Beijing Friendship Hospital, Capital Medical University Beijing, China.
authors.forename: Zhi-Jie
authors.initials: ZJ
authors.lastname: Ma
authors.affiliation: China Military Institute of Chinese Medicine, 302 Military Hospital of People's Liberation Army Beijing, China.
authors.forename: Jia-Bo
authors.initials: JB
authors.lastname: Wang
authors.affiliation: Department of Pharmacy, 302 Military Hospital of People's Liberation Army Beijing, China.
authors.forename: Yan-Ling
authors.initials: YL
authors.lastname: Zhao
authors.affiliation: China Military Institute of Chinese Medicine, 302 Military Hospital of People's Liberation Army Beijing, China.
authors.forename: Xiao-He
authors.initials: XH
authors.lastname: Xiao
keywords: Compound Kushen Injection; meta-analysis; systematic review; transarterial chemoembolization; unresectable hepatocellular carcinoma