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Chinese herbal medicines for induction of remission in advanced or late gastric cancer

  1. Jinlin Yang1,*,
  2. Linlin Zhu1,
  3. Zongying Wu2,
  4. Yiping Wang1

Editorial Group: Cochrane Upper Gastrointestinal and Pancreatic Diseases Group

Published Online: 30 APR 2013

Assessed as up-to-date: 8 OCT 2011

DOI: 10.1002/14651858.CD005096.pub4


How to Cite

Yang J, Zhu L, Wu Z, Wang Y. Chinese herbal medicines for induction of remission in advanced or late gastric cancer. Cochrane Database of Systematic Reviews 2013, Issue 4. Art. No.: CD005096. DOI: 10.1002/14651858.CD005096.pub4.

Author Information

  1. 1

    West China Hospital, Sichuan University, Department of Gastroenterology, Chengdu, Sichuan, China

  2. 2

    Third Hospital of Mianyang, Department of Digestive Diseases, Mianyang, China

*Jinlin Yang, Department of Gastroenterology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, Sichuan, 610041, China. mouse-577@163.com. wuzl_basehouse@163.com.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 30 APR 2013

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Summary of findings    [Explanations]

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Sources of support
  17. Notes
  18. Index terms

 
Summary of findings for the main comparison. Appraisal of the results of Huachansu in the short term for induction of remission in advanced or late gastric cancer

Appraisal of the results of Huachansu in the short term for induction of remission in advanced or late gastric cancer

Patient or population: patients with induction of remission in advanced or late gastric cancer
Settings:
Intervention: Appraisal of the results of Huachansu in the short term

OutcomesIllustrative comparative risks* (95% CI)Relative effect
(95% CI)
No of Participants
(studies)
Quality of the evidence
(GRADE)
Comments

Assumed riskCorresponding risk

ControlAppraisal of the results of Huachansu in the short term

the toxic and side effects in digestive system after chemotherapy (no special data in trial of Zhang 2006)
Follow-up: 6-24 weeks
Study populationOR 0.43
(0.28 to 0.66)
388
(6 studies)
⊕⊝⊝⊝
very low1,2,3

589 per 1000381 per 1000
(286 to 486)

Moderate

523 per 1000320 per 1000
(235 to 420)

the rate of complete remission and partly remission (Copy)
Follow-up: 6-24 weeks
Study populationOR 1.48
(1.01 to 2.17)
448
(7 studies)
⊕⊝⊝⊝
very low1,2,3

401 per 1000498 per 1000
(403 to 592)

Moderate

367 per 1000462 per 1000
(369 to 557)

the toxic and side effects of leukopenia after chemotherapy(no special data in trial of Zhang 2006)
Follow-up: 6-24 weeks
Study populationOR 0.32
(0.21 to 0.5)
388
(6 studies)
⊕⊝⊝⊝
very low1,2,3

583 per 1000309 per 1000
(227 to 412)

Moderate

539 per 1000272 per 1000
(197 to 369)

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; OR: Odds ratio;

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

 1 The method of sequence generation was not offered by the authors in three studies,quasi-randomised for three trials,and one simple randomisation study.
2 Allocation concealment and blinding of the method were not offered by the seven study authors.
3 total (cumulative) sample size is lower than the calculated optimal information size

 Summary of findings 2 Appraisal of the results of Aidi in the short term for induction of remission in advanced or late gastric cancer

 Summary of findings 3 Appraisal of the results of Fufangkushen in the short term for induction of remission in advanced or late gastric cancer

 Summary of findings 4 Appraisal of the results of Shenqifuzheng in the short term for induction of remission in advanced or late gastric cancer

 

Background

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Sources of support
  17. Notes
  18. Index terms

In general, therapeutic prescriptions of traditional Chinese medicinal herbs (TCMHs) for gastric cancer consist of a group of herbs (commonly seven to 15 kinds of herbs). Some, such as Rhizoma Curcumae, Herba Hedyotis Diffusae, Rhizoma Paridis, Astragali radix, Radix Clematidis, and Fructus Bruceae, are commonly used as direct anti-tumour agents and others, such as Tangerine peel, Milk vetch root, Pilose asiabell root, Spatholobus stem, Chinese angelica root, Flos Carthami, and Red sage root, can be added to the main prescription as supporting treatments to decrease the side effects or toxicity of chemotherapy (Ning 1985) or to improve the curative effect. This is described as 'strengthening the body resistance, restoring normal functioning of the body to consolidate the constitution, relieving the depressed liver and soothing the stomach, invigorating qi and enriching the blood, removing the poisonous quality of any substance and resolving the stasis'. These are the terms used in traditional Chinese medical theory (Gu 1995). Unfortunately, there still seems to be no special herbs or recipes that have been found to have special effects on certain kinds of cancers, so these same TCMHs can be used for other malignant tumours such as oesophageal carcinoma, hepatocarcinoma, or pulmonary carcinoma. At present, TCMHs are not recommended to treat benign tumours, such as polyps, because such diseases can be cured effectively by surgery.

Medicines in complex prescriptions can be given by oral administration or intravenous drip, and there are many case reports showing that patients have been treated effectively with TCMHs administered either orally or intravenously, or by both methods (Duan 2002). The combination administration is based on the special diagnostic modes of Traditional Chinese Medicine (TCM), such as inspection, listening, smelling, inquiry, and palpation, which mainly depend on the experience of doctors and are very different from western diagnostic methods. Although many trials appear to demonstrate that TCMHs might have some effectiveness on cancer, there is no evidence showing that TCMHs could replace surgery or radio-chemotherapy for cancer in its early stages. At present, TCMHs are mainly used as an auxiliary therapy and a palliative treatment with routine therapeutic methods for advanced or late cancer, including gastric cancer.

 

Description of the condition

Although many cancers can be cured in the early stages, once they progress to advanced or late stage (that is once widespread metastasis is confirmed by medical techniques such as X-ray computed tomography (X-CT), magnetic resonance imaging (MRI), or histologic examination) there are few interventions which can postpone or stop the malignant illness leading to death. Although bio-therapies, such as gene therapy, immune therapy, bone-marrow transplantation, etc, have made some progress in some kinds of advanced or late cancers, the mortality rate of most common late malignancy tumours (such as carcinomas derived from the digestive tract, gastric cancer, hepatocarcinoma) is still high. Both the morbidity and mortality of gastric cancer rank second of all malignant tumours (Tang 2004), varying from 30 per 10⁵ to 80 per 10⁵ and 15.9 per 10⁵ to 32.4 per 10⁵, respectively (Zheng 2001), in different countries and regions. According to the statistical data, China, Japan, and Chile are countries with high risk of morbidity and mortality, and the United States, Canada, and European countries are those with low risk (Tang 2004).

 

Description of the intervention

TCM is a common alternative therapy in China for late-stage cancer, and all the herbs cited in this review can be found in the Traditional Chinese Medicine Dictionary. TCM has its own theories and systems for diagnostic and therapeutic methods for malignant tumours. It is thought that gastric cancer, called ye-ge (similar to dysphagia) (Yang 1989), is caused mainly by overactive emotions (joy, anger, sorrow, anxiety, and fear) and eating or drinking too much, resulting in internal stasis of Yangqi and consumption of Yin fluid. Yin-Yang theories of TCM, derived from Taoism, state that there are two substances, Yin and Yang, in the human body and that they should match each other to keep the balance, otherwise the body is at risk of all kinds of diseases. According to matched control research, it is shown that highly differentiated gastric adenocarcinoma (Wang 2000) is similar to insufficiency of the spleen (Yang), or lack of coordination between the liver and the spleen; and poorly differentiated gastric adenocarcinoma is similar to deficiency of both qi and blood, or stagnancy of qi and blood stasis. In TCM, qi means something similar to air. The theories of TCM believe there is a kind of air running throughout the entire human body, not only in the lungs but in every organ of the body, and some people can feel its existence through breathing exercises; though this viewpoint has not been proven by modern western science.

In traditional Chinese medicinal theory, therapeutic strategies aimed at late or advanced gastric cancer include three basic principles (Ji 1989):

  • replenishing and strengthening the vital-qi;
  • reducing phlegm and resolving stasis;
  • clearing away heat and toxic material.

 

How the intervention might work

According to the principle that treatment of a disease should deal with both the symptoms and causes at the same time, some categories of traditional Chinese medicinal herbs (TCMHs) are used according to the Chinese medicinal typing of advanced or late gastric cancer (Guo 1997) as alternative interventions. It is generally acknowledged that in its early stages gastric cancer can be cured with surgery, so alternative interventions (including TCMHs) are unnecessary. Once metastasis develops (that is in advanced or late-stage disease) and the opportunity for surgery is lost, the cancer can not be cured. Therefore alternative interventions, including TCMHs, are used either alone or as auxiliary therapies with radio-chemotherapy or bio-therapy (Zheng 2001).

Though the basic research on TCMHs is still weak, and most of the active ingredients are not extracted and confirmed at present, It is believed that some TCM herbs (including Astragulus membranaceus, dandelion herb, cassia twig, Poria, magnolia bark, chaenomeles fruit, costus root, barbat skullcap, lyrate nightshade, Chinese actinidia root, Coix seed, globethistle, hornet nest (Zhou 1999), and others such as bighead atractylodes rhizome, Oldenlandia diffusa Roxb (Wu 2001), Scutellaria baicalensis Georgi, Allium sativum L As2O3) could inhibit the proliferation of gastric tumour cells (Sun 2002; Zhao 2002). Some basic research showed that isoverbascoside (Chen 2001), found in Pedicularis strata, has the effect of cleaning up multifarious oxyradicals. This could transfer the growth signal in the gastric cancer cell thus inhibiting the proliferation of gastric cancer. Astragulus membranaceus, a commonly used herb (Shen 2007) can down-regulate the expression of cyclooxygenase-2 (COX-2), vascular endothelial growth factor (VEGF), and polyethylene glycol (PEG)-2 in the gastric cancer cells. Radix Astragali specifically inhibits the growth of gastric cancer cells in vitro, but it is mainly cytostatic and not cytotoxic and does not induce apoptosis (Lin 2003). Another result from a pilot study suggests that a polysaccharide isolated from Echinacea purpurea herba cell cultures might be effective in reducing chemotherapy-induced leukopenia (Melchart 2002); and the extract from Radix Curcumae, obtained by steam distillation, has a chemopreventive effect on gastric cancer induced by N-methyl-N'-nitro-N-nitrosoguanidine (MNNG) in rats (Lu 2008). Furthermore, the alkaloid Matrine can inhibit cell proliferation and induce apoptosis of SGC-7901 cells in vitro; the apoptosis induction appears to be through up-regulating Fas/FasL expression and activating caspase-3 enzyme (Dai 2009). Aidi injection, a commonly used TCM recipe in China, appears to have the effect of inhibiting the proliferation of cancer cells, including gastric cancer cells, but the effect is uncertain and needs to be assessed more thoroughly (Sa 2003). Other TCMHs can improve immunity (Bu 2001b; Lu 1996), for example Fuzhenghuayu Recipe can improve the function of T-cells and inhibit metastasis after surgery in patients with gastric cancer. Some herbal recipes are believed to reduce the incidence of atypical hyperplasia in the gastric mucosa (Qiu 1993), and many TCMHs (including Sijunzi decoction, As2O3, Radix Astragali seu Hedysari, Bulbus Alliican) lead to apoptosis of gastric cancer cells (Wu 2001) by inducing expression of gene P53, P21. Huoxuehuayu recipe has the same effect, by inducing over-expression of Bcl-2 and inhibiting the expression of epidermoid growth factor receptors (EGFR).

 

Why it is important to do this review

TCMHs have been used widely and for many years to treat gastric cancer. Much clinical experience has been summarised and the first randomised controlled trial (RCT) appeared in 1986 (Zeng 1986). Most of the literature about TCMH for gastric cancer, especially the RCTs (Huang 2005; Liu 2006a; Xie 2006), have concluded that the TCMHs have positive effects on quality of life, prolonging the life span, and alleviating adverse events caused by routine chemotherapy, but the effectiveness and adverse effects of TCMHs have not been assessed systematically. The objective of this review was to assess the effectiveness of TCMHs for eradicating gastric cancerous cells and to determine whether TCMHs can improve the patient's general condition and prolong the average life span compared with routine clinical therapy for late or advanced gastric cancer, such as chemotherapy and radiotherapy.

 

Objectives

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Sources of support
  17. Notes
  18. Index terms

1. To appraise the improvement of and remission in patients by comparing the intervention group (TCMHs) with the control group (no TCMHs), including:

(i) studies which compared TCMH to placebo (these may be either with or without concomitant treatment); or

(ii) studies which compared TCMH to other treatments.

The efficacy parameters included mortality and median survival time, time to progression, quality of life.

2. To determine adverse events associated with TCMH treatment in patients with advanced or late gastric cancer.

 

Methods

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Sources of support
  17. Notes
  18. Index terms
 

Criteria for considering studies for this review

 

Types of studies

Randomised controlled trials (RCTs) which compared TCMHs with either placebo or other drugs.

 

Types of participants

  1. Patients of any age whose final diagnosis was T (tumour) 1 to 4, N (lymph nodes) 1 to 3, M (metastasis) 1, confirmed by the new tumour, node, metastasis (TNM) descriptive stage (UICC 1997) and for whom surgery was not an option. This descriptive stage means that metastasis exists and the cancer has gone into advanced or late stage, that is, III or IV.
  2. Patients who have confirmed recurrence of gastric cancer accompanied by distant metastasis after operation.

 

Types of interventions

RCTs of TCMH (oral or intravenous administration, or both) used for treatment of patients with advanced or late-stage gastric cancer. This included TCMH treatment studies and clinical trials in which TCMHs were added to the other treatments for patients in advanced or late-stage gastric cancer.

 

Types of outcome measures

Endoscopic, radiographic, clinical, or histological remission as defined by the primary studies and expressed as a percentage of the number of patients randomised (intention-to-treat analysis) was the outcome measure of interest. Since definitions of advanced or late-stage disease can vary from trial to trial, we used the individual definitions from each study. The number of patients with clinical improvement or remission of advanced or late gastric cancer was recorded. The exact definition of improvement and remission also varied from study to study, making exact comparisons across studies difficult or impossible. However, for the purpose of this analysis, we used the definition of improvement or remission as used in each study for extraction of data from the individual studies.

Other outcomes of interest included life span, drug adverse effects, withdrawals for toxicity or adverse events, and the effects of drug interactions.

 

Primary outcomes

  1. Mortality

 

Secondary outcomes

  1. Quality of life (QOL): the QOL index was assessed by the Karnofsky score, if the score increased to over 10 at the end of the therapeutic period it was defined as improvement of QOL.
  2. Rate of remission (short-term and long-term): following the standards of the International Union Against Cancer (UICC), the rate of remission included complete remission (the tumour disappeared in a period of at least three months) and part remission (half of the tumour disappeared over at least three months).
  3. Median survival time (MST): MST is the median value for patient survival time.
  4. Time to progression (TTP): the time from the stage of remission to the stage of advancing cancer, i.e., the time for tumour relapse.

Adverse events:

  1. life threatening;
  2. toxic response;
  3. resulting in the discontinuation of treatment.

The side effects were those caused by either Chinese medicinal herbs or the comparator, or both.

 

Search methods for identification of studies

See: Cochrane Upper Gastrointestinal and Pancreatic Diseases Group methods used in reviews.

We conducted a search to identify all published and unpublished RCTs.

 

Electronic searches

We searched the following electronic databases:

  • The Cochrane Library (Issue 3, 2011) (Appendix 1),
  • MEDLINE (from 1950 to June 2011) (Appendix 2),
  • EMBASE (from 1980 to June 2011) (Appendix 3),
  • AHMED (Allied and Complementary Medicine Database), and
  • CBM (Chinese Biomedical Database) (from 1974 to June 2011) (Appendix 4).

The search strategy for the review was constructed by using a combination of MeSH subject headings and text words relating to the use of TCMHs in the treatment of advanced or inoperable gastric cancer.

 

Searching other resources

We handsearched reference lists from trials selected by electronic searching to identify further relevant trials. We contacted authors of identified studies to request any further published or unpublished work.

We handsearched the following journals:

  • Acta Medicinae Sinica,
  • Cancer Research on Prevention and Treatment,
  • China Journal of Chinese Materia Medica,
  • China Oncology,
  • Chinese Journal of Cancer Research,
  • Chinese Journal of Clinical Oncology and Rehabilitation,
  • Chinese Journal of Integrated Traditional and Western Medicine on Digestion,
  • Chinese Journal of Oncology,
  • Chinese Journal of Radiation Oncology,
  • Henan Journal of Traditional Chinese Medicine,
  • Jiangshu Journal of Tradition Chinese Medicine,
  • Journal of Beijing of Tradition Chinese Medicine,
  • Journal of Fujian of Traditional Chinese Medicine,
  • Journal of Jilin of Traditional Chinese Medicine,
  • Journal of Practical Oncology,
  • Journal of Nanjing University of Traditional Chinese Medicine,
  • Journal of Sichuang of Traditional Chinese Medicine,
  • JTCM (Journal of Traditional Chinese Medicine),
  • Traditional Chinese Medicinal Research.

In addition, we contacted the World Health Organization, experts in the field, and medicinal herb manufacturers to request details of outstanding clinical trials or any relevant unpublished materials.

 

Data collection and analysis

Where appropriate, we combined the extracted data (Parmar 1998) from the various trials by calculating a pooled estimate of the odds ratio using the method of Mantel-Haenszel, the relative risk and risk difference, and the 95% confidence intervals for dichotomous data. We used both fixed-effect and random-effects models. Where outcomes were measured as continuous data in a standard way across studies, we calculated the weighted mean difference and 95% confidence interval using a random-effects model. Dropouts were analysed according to the principle of inefficiency in the intervention group and efficiency in the control group, and these conservative results were recorded.

 

Selection of studies

Three authors reviewed potentially relevant studies to determine their eligibility based on the criteria (and mortality, MST, TTP, QOL outcomes) described above.

 

Data extraction and management

Three review authors independently appraised each study and recorded the methodological criteria and the results of each study on standard data forms. For crossover studies, only data from the first portion of the study would have been incorporated in order to avoid possible carryover effects of medications into the second part of the study, and to make these studies more comparable to those studies not of crossover design. We determined all results on an intention-to-treat basis.

 

Assessment of risk of bias in included studies

The criteria for assessment of risk of bias included the specific methods of randomisation and allocation concealment, the blinding method, and reporting of dropouts or withdrawal of patients according to the Cochrane Handbook for Systematic Reviews of Interventions, Table 8.5.c (criteria for judging risk of bias in the 'risk of bias' assessment tool) (Higgins 2008).

 

Measures of treatment effect

If the heterogeneity across the included trials was low the treatment effects were pooled in a meta-analysis, or a descriptive method was used.

 

Unit of analysis issues

There was a unit of analysis issue for one study. General information about the included studies is provided in the 'Characteristics of included studies' table.

 

Dealing with missing data

Analyses were performed on an intention-to-treat basis if data were missing. For dichotomous data, patients in the treatment group with incomplete or missing data were regarded as treatment failures and those in the control group were regarded as treatment successes. According to this principle, a 'worst-best case' scenario analysis would be carried out.

 

Assessment of heterogeneity

The heterogeneity of the included studies mainly resulted from the different recipes of TCHM used, assessed in the Results section.

 

Assessment of reporting biases

No

 

Data synthesis

The dichotomous data were presented as relative risk (RR), and continuous outcomes by weighted mean difference (WMD), if possible, both with 95% confidence intervals (CI).

 

Subgroup analysis and investigation of heterogeneity

No

 

Sensitivity analysis

Where meta-analysis was performed, we also carried out a sensitivity analysis.

 

Results

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Sources of support
  17. Notes
  18. Index terms
 

Description of studies

See: Characteristics of included studies; Characteristics of excluded studies.

 

Results of the search

Our completed searches (June 2011) identified 179 articles: 172 from the electronic searches and seven from handsearching. After reading titles, abstracts, and the content of the articles we excluded 99 because they had study objectives that were different from those for this review, the reasons for exclusion are listed under Characteristics of excluded studies. The remaining 80 articles were selected for further assessment.

 

Included studies

 

Design

All of the included studies had a parallel design and no crossover design was used.

According to the intervention measures, the 80 articles were subdivided into four types:

  1. TCMHs plus western therapeutic methods in the intervention group versus the same western therapeutic methods in the control group (type I in  Table 1, 65 articles),
  2. TCMHs plus western therapeutic methods in the intervention group versus the same TCMHs in the control group (type II in  Table 2, six articles),
  3. TCMHs in the intervention group versus other TCMHs in the control group (type III in  Table 3, two articles),
  4. TCMHs in the intervention group versus western therapeutic methods in the control group (type IV in  Table 4, seven articles).

All the specific herbs used in the articles are listed in Tables 1 to 4 (Additional tables). None of the trials implemented blinding methods. We found no RCTs comparing a single herb with another single herb or herbal compounds. No placebo controlled trials were identified. We excluded another 99 articles because they did not meet our inclusion criteria. The reasons for exclusion, mainly because the selected patients did not have a TNM stage or the study was not a RCT, are listed under Characteristics of included studies.

 
Type I (TCMHs plus western therapeutic methods versus the same western therapeutic methods)

The 65 articles in type I included four kinds of injected TCMHs (a total of 23 trials for meta-analysis) and reported random allocation of 5483 patients with advanced or late gastric cancer (ALGC) to TCMHs plus western therapeutic methods versus the same western therapeutic methods. Treatment was with non-patented TCMHs in 24 trials and with patented TCMHs in 41 trials. The commonly used herbs were:

An emulsion of Lanxiangxi was used in five trials (Cao 1997; Deng 2001; Guan 2001; Tian 1999; Wu 2000a), and others in 17 trials.

In the 65 trials the western therapeutic interventions were:

  • regimen of MFV (mitomycin C 4 mg intravenously (iv) drop factor (gtt) once daily (qd) X 1 day + fluorouracilum 0.5 to 1.0 iv gtt qd X 1 to 5 days + vincristine sulphate 2 mg iv qd X 1 to 2 days per week X 4 to 6) as comparator in 7 trials,
  • regimen of ELF (etoposide 100 mg/m² iv gtt qd X 1 to 5 days + lencovorin 100 mg/m² iv gtt qd X 1 to 5 days + fluorouracilum 500 mg/m² iv gtt qd X 1 to 5 days per week X 2) as comparator in 18 trials,
  • regimen of FAM (fluorouracilum 100 mg/m² iv gtt qd X 1 to 5 days + adriamycinum 30 to 40 mg/m² iv qd X 1 day + mitomycin C 8 to 10 mg/m² iv qd X 1 day per week X 3 to 4) as comparator in 6 trials,
  • regimen of EAP (etoposide 100 mg/m² iv gtt qd X 4 to 6 days + adriamycinum 30 mg/m² iv qd X 1, 7 days + cisplatinum 40 mg/m² iv gtt qd X 2, 8 days per period X 2) as comparator in 3 trials,
  • regimen of OFL (oxaliplatin 70 mg/m² iv gtt day 1 + calcium folinate 400 mg/m² iv gtt day 1 + fluorouracilum 500 mg/m² iv gtt day 1 to 5 per week X 3 to 4) in 4 trials,
  • regimen of FOLFOX4 (oxaliplatin 100mg/m² iv gtt day 1 + calcium folinate 200 mg/m² iv gtt day 1 to 5 + fluorouracilum 500 mg/m² iv gtt day 1 to 5 per week X 6) in 6 trials,
  • regimen of TPF (paclitaxel 175 mg/m² iv gtt day 1 + cisplatinum 200 mg/m² iv gtt day 1 to 5 + fluorouracilum 600 mg/m² iv gtt day 1 to 5 per week X 6) in 3 trials, and
  • others in 19 trials.

The relevant contents are described in the 'Additional tables' ( Table 1: administration of Chinese medical herbs (TCMHs + medicine versus medicine)).

In type I, seven trials (Chen 2009; Wang 2009a; Wang 2010b; Zhang 2001; Zhang 2004; Zhang 2005; Zhang 2006) used the same TCMH (Huachansu) with a similar dosage and therapeutic period. In the seven identified trials, the age ranged from 25 to 82 years in the intervention group and from 23 to 75 years in the control group; the number of cases varied from 20 to 43 in the intervention group and from 23 to 43 in the control group. All five trials except two (Wang 2010b; Zhang 2001), which only contained patients in stage IV, contained patients from both stages III and IV. The Huachansu was given by iv gtt 10 to 30 ml qd X 10 to 28 days in the intervention group during one therapeutic period, so the included participants, interventions, and outcomes were similar enough to allow combination of the data for meta-analysis. The number of patients in each trial was too small to carry out subgroup analyses. In each trial, the same chemotherapeutic regimen and period were used for patients in the intervention group and the control group:

  • in the first trial (Chen 2009), the regimen was TPF (paclitaxel 175 mg/m² iv gtt day 1 + cisplatinum 200 mg/m² iv gtt day 1 to 5 + fluorouracilum 600 mg/m² iv gtt day 1 to 5 per week X 6);
  • in the second trial (Wang 2009a), the regimen was FOLFOX4 (oxaliplatin 85 mg/m² iv gtt day 1 + calcium folinate 100 mg/m² iv gtt day 1 to 2 + fluorouracilum 400 mg/m² iv day 1 to 2 + fluorouracilum 600 mg/m² iv gtt day 1 to 2 per week X 8);
  • in the third trial (Wang 2010b), the regimen was FOLFOX4 (oxaliplatin (85 to 100 mg/m² iv gtt day 1 + calcium folinate 200 mg/m² iv gtt day 1 to 2 + fluorouracilum 400 mg/m² iv day 1 to 2 + fluorouracilum 600 mg/m² iv gtt day 1 to 2 per week X 16);
  • in the fourth trial (Zhang 2001), the regimen was ELF (etoposide 100 mg/m² iv gtt qd X 1 to 5 days + lencovorin 100 mg/m² iv gtt qd X 1 to 5 days + fluorouracilum 500 mg/m² iv gtt qd X 1 to 5 days per week X 2);
  • in the fifth trial (Zhang 2004), the regimen was HLF (10-hydroxycamptothecine 7 mg/m² iv gtt qd X 1 to 5 days + lencovorin 200 mg/m² iv gtt qd X 1 to 5 days + fluorouracilum 500 mg/m² iv gtt qd X 1 to 5 days per week X 3);
  • in the sixth trial (Zhang 2005), the regimen was FLO (oxaliplatin 130 mg/m² iv gtt qd X 1 days + lencovorin 200 mg/m² iv gtt qd X 1 to 3 days + fluorouracilum 500 mg/m² iv gtt qd X 1 to 3 days per week X 3); and
  • in the seventh trial (Zhang 2006), the regimen was HCPT (10-hydroxycamptothecine 5 mg iv gtt qd X 1 to 5 days per week X 3).

None of the seven trials except one (Chen 2009) explained the specific method of randomisation (drew a lot) except to simply mention that randomisation was used.

In type I, six trials (Chen 2008; Gong 2006; Jia 2003; Liu 2009; Wang 2009; Zhang 2009) used the same TCMH (Aidi) with a similar dosage and therapeutic period. In the six identified trials, the age ranged from 30 to 78 years in the intervention group and from 35 to 85 years in the control group; the number of cases varied from 23 to 35 in the intervention group and from 22 to 34 in the control group. All six trials contained patients in both stage III and IV. The AIdi was given by iv gtt 50 ml qd X 10 to 42 (mostly 10 to 21) days in the intervention group during the therapeutic period, so the included participants, interventions, and outcomes were similar enough to allow the combination of data for meta-analysis. The number of patients in each trial was too small to carry out subgroup analyses. In each trial, the same chemotherapeutic regimen and period were used for patients in the intervention group and the control group:

  • in the first trial (Chen 2008), the regimen was FOLFOX4 (oxaliplatin 85 mg/m² iv gtt day 1+ calcium folinate 200 mg/m² iv gtt day 1 to 2 + fluorouracilum 400 mg/m² iv gtt day 1 + fluorouracilum 600 mg/m² iv gtt day 2 per week X 6);
  • in the second trial (Gong 2006), the regimen was TCF (paclitaxel (Taxol) 135 mg/m² iv, day 1 + fluorouracilum 500 mg/m² iv (4 h) day 1 to 5 + calcium folinate 100 mg/m² iv day 1 to 5 + cisplatinum 30 mg/m² Iv gtt day 1 to 3 per week X 12);
  • in the third trial (Jia 2003), the regimen was CF (fluorouracilum 500 mg/m² iv gtt day 1 to 5 + cisplatinum 50 mg iv gtt day 1 to 3 per week X 6);
  • in the fourth trial (Liu 2009), the regimen was TPF (paclitaxel (Taxol) 175 mg/m² iv gtt day 1+ cisplatinum 20 mg/m² iv gtt day 1 to 5 + fluorouracilum 600 mg/m² iv gtt day 1 to 5 per week X 8);
  • in the fifth trial (Wang 2009), the regimen was FAM (fluorouracilum 0.5 iv day 1 + adriamycinum 20 mg iv day 1 + mitomycin C 20mg iv day 1 X 12 weeks);
  • in the sixth trial (Zhang 2009), the regimen was FOLFOX4 (L-OXA 100 mg/m² iv gtt day 1+ LV 200 mg/m² iv gtt day 1 to 2 + 5-FU 400 mg/m² iv day 1 to 2 + 5-FU 600mg/m² ) iv day 1 to 2 per week X 9).

None of the six trials except one (Liu 2009) explained the specific method of randomisation (drew a lot) except to mention simply that randomisation was used.

In type I, seven trials (Fu 2011; Lin 2011; Liu 2009a; Wang 2010a; Xiong 2008; Zhang 2010; Zhang 2010b) used the same TCMH (Fufangkushen) with a similar dosage and therapeutic period. In the seven identified trials, the age ranged from 30 to 73 years in the intervention group and from 32 to 75 years in the control group; the number of cases varied from 25 to 48 in the intervention group and from 25 to 48 in the control group. All seven trials except Xiong 2008, which contained patients in stage IV, contained patients in both stage III and IV. The Fufangkushen was given by iv gtt 20 ml qd X 10 to 28 days in the intervention group during the therapeutic period, so the included participants, interventions, and outcomes were similar enough to allow combination of the data for meta-analysis. The number of patients in each trial was too small to carry out subgroup analyses. In each trial, the same chemotherapeutic regimen and period were given to the patients in the intervention group and the control group:

  • in the first trial (Fu 2011), the regimen was FLO (oxaliplatin 85 mg/m² iv gtt day 1 + calcium folinate 200 mg/m² iv gtt day 1 + fluorouracilum 2600 mg/m² iv gtt day 1 per week X 4);
  • in the second trial (Lin 2011), the regimen was FDO (oxaliplatin 130 mg/m² iv gtt day 1 + docetaxe 75 mg/m² iv gtt day 1 + fluorouracilum 1500 mg/m² iv gtt day 1, 8 per week X 9);
  • in the third trial (Liu 2009a), the regimen was FOT (oxaliplatin 130 mg/m² iv gtt day 1 + calcium folinate 100 mg/m² iv gtt day 1 to 5 + tegafur 1000 mg/m² iv gtt day 1 to 5 per week X 6);
  • in the fourth trial (Wang 2010a), the regimen was DCF (docetaxel 30 mg/m² iv gtt day 1, 8 + cisplatinum 20 mg/m² iv gtt day 1 to 5 + fluorouracilum 750 mg/m² iv gtt day 1 to 5 per week X 6);
  • in the fifth trial (Xiong 2008), the regimen was TO (paclitaxel (Taxol) 130 mg/m² iv gtt day 1 + oxaliplatin 135 mg/m² iv gtt day 2 per week X 9);
  • in the sixth trial (Zhang 2010) the regimen was ECF (epirubicin 50 mg/m² iv gtt day 1 + cisplatinum 60 mg/m² iv gtt day 1 + fluorouracilum 600 mg/m² iv day 1 to 5 per week X 3);
  • in the seventh trial (Zhang 2010b), the regimen was FLP (cisplatinum 20 mg/m² iv gtt day 1 to 5 + calcium folinate 200 mg/m² iv gtt day 1 to 5 + fluorouracilum 500 mg/m² iv gtt day 1 to 5 per week X 6 to 8).

None of the seven trials except two trials (Wang 2010a; Zhang 2010) explained the specific method of randomisation (drew a lot and random number table, respectively) except to mention simply that randomisation was used.

In type I, three trials (Jia 2009; Luo 2011; Wang 2010), used the same TCMH (Shenqifuzheng) with a similar dosage and therapeutic period. In the three identified trials, the age ranged from 26 to 75 years in the intervention group and from 33 to 75 years in the control group; the number of cases varied from 22 to 32 in the intervention group and from 21 to 30 in the control group. All three trials except (Luo 2011), which only contained patients in stage IV, contained patients in both stage III and IV. The Shenqifuzheng was given by iv gtt 250 ml once daily (qd) X 10 to 31 days in the intervention group during the therapeutic period, so the included participants, interventions, and outcomes were similar enough to allow combination of the data for meta-analysis. The number of patients in each trial was too small to carry out subgroup analysis. In each trial, the same chemotherapeutic regimen and period were used for patients in the intervention group and the control group:

  • in the first trial (Jia 2009), the regimen was FOLFOX4 (oxaliplatin 85 mg/m² iv gtt day 1+ calcium folinate 200 mg/m² iv gtt day 1 to 2 + fluorouracilum 600 mg/m² iv + fluorouracilum 400 mg/m² iv gtt day 1 to 2 per week X 8);
  • in the second trial (Luo 2011), the regimen was FLO (oxaliplatin 130 mg/m² iv gtt day 1+ calcium folinate 100 mg/m² iv gtt day 1 to 5 + fluorouracilum 200 mg/m² iv gtt day 1 to 5 per week X 6);
  • in the third trial (Wang 2010), the regimen was LF regimen (day 1 to 4, day 28 to 31, no specific dosage).

None of the three trials explained the specific method of randomisation except to simply mention that randomisation was used.

 
Type II (TCMHs plus western therapeutic methods versus the same TCMHs)

The six articles (Chen 1997a; Liu 2002; Wang 1998; Xu 1989; You 2005; Zhao 2005) in type II reported random allocation of 587 patients with advanced or late gastic cancer to TCMHs plus western therapeutic methods versus control (treatment with non-patented TCMHs in five trials, the commonly used herbs listed). The relevant contents are described in the 'Additional tables' ( Table 2: administration of Chinese medicinal Herbs (TCMHs plus medicine versus TCMHs)).

 
Type III (TCMHs versus other TCMHs)

The two articles (Shao 1998; Shi 2004) in type III reported random allocation of 194 patients with advanced or late gastric cancer to TCMHs versus control (treatment with non-patented TCMHs in one trial, the commonly used herbs listed; treatment with patented TCMHs, compound oral fluid Zhenjian in one trial (Shao 1998)). The relevant contents are described in the 'Additional tables' ( Table 3: administration of Chinese medicinal herbs (TCMHs versus other TCMHs)).

 
Type IV (TCMHs versus western therapeutic methods)

The seven articles (Jiang 1994; Li 2001; Yang 2006; Yang 2010; Ye 2009; You 2000; Zhou 2000) in type IV reported random allocation of 593 patients with advanced or late gastric cancer to TCMHs versus control (treatment with non-patented TCMHs in four trials, the commonly used herbs). The relevant contents are described in the 'Additional tables' ( Table 4: administration of Chinese medicinal herbs (TCMHs versus medicines)).

 

Sample sizes

None of the trials reported a sample size calculation. In type I, the sample sizes varied from 36 to 249 cases, with a mean value of 84. In type II, the sample sizes varied from 41 to 246 cases, with a mean value of 144. In type III, the sample sizes varied from 51 to 143 cases, with a mean value of 97. In type IV, the sample sizes varied from 60 to 176 cases, with a mean value of 85.

 

Setting

Both inpatients and outpatients were Included. In type I, only 33 trials included inpatients and no trial included only outpatients. Three trials included both inpatients and outpatients; the other 29 trials did not specify the status of the patients. In type II, four trials included inpatients and the other trials did not specify the status of the patients. In type III, one trial included inpatients and the other trial did not specify the status of the patients. In type IV, three trials included inpatients and the other trials did not specify the status of the patients. No special medicine was given to patients as primary care.

 

Participants

All the patients in the 80 trials were adults with gastric cancer in stage III or IV (that is T 1-4, N 1-3, M1). None of the trials reported the specific ratio of gender for all participants, and the general ratio of male to female was close to 2:1. In type I, the age of the participants varied from 22 to 85 years in 46 trials, another 19 trials did not specify the age range, and the mean age was 54 years. In type II, the age of the participants varied from 28 years to 72 years in six trials, and the mean age was 62 years. In type III, the age of the participants varied from 30 years to 79 years in two trials, and the mean age was 54 years. In type IV, the age of the participants varied from 22 years to 85 years in five trials, and the mean age was 62 years. The other two trials did not give data on the participants' age.

 

Interventions

The intervention (TCMHs) consisted of patented herbal medicine and self-produced herbal compounds. The method of administration was by the oral route in 40 trials, and by intravenous administration in the other 40 trials. The period of administration varied from two weeks to one year, with a median period of one to three months. The specific dosage (range 10 g to 50 g) of the herbs and the regimens, which commonly consisted of seven to 15 herbs, are listed in  Table 1;  Table 2;  Table 3;  Table 4, but some authors did not specify the dosage of herbs because of commercial or technological secrecy. In the 80 trials, there were more than 200 categories of herbs used for treating gastric cancer in the advanced or late stage. The frequency (≥ 20%) of the most commonly used TCMHs in the 80 trials was: Radix Astragali seu Hedysari 50.0% (40/80), Rhizoma Atractylodis Macrocephalae 30.0% (24/80), Poria 30.0% (24/80), Radix Codonopsis Pilosulae 30.0% (24/80), Rhizoma Zedoariae 20.0% (16/80), Semen Coicis 20.0% (16/80).

Due to the lack of a reliable and recognised standards, it should be emphasised that the definition of TCMHs is non-specific and the associated concepts are diverse.

 

Outcomes

The commonly reported outcomes were mortality, improvements in quality of life (QOL), rate of remission (short-term and long-term), median survival time (MST), time to progression (TTP), as well as adverse effects, such as life threatening and toxic responses, resulting in the discontinuation of treatment.

 

Excluded studies

Most of the excluded studies had no clear TNM stage and the illness of some patients was not in the late or advanced stage. A few of the studies were not related to TCMH or TCMH for gastric cancer, so they were excluded for this reason.

 

Risk of bias in included studies

The methodological quality of the 80 included studies was very poor (Figure 1). Other than mentioning that the studies were randomised, none of the trials gave any information that would allow a formal assessment of quality. Most of the articles described the method of randomisation that was used, but none of the trials described double blinding or the methods used for blinding. Only five trials provided a description of withdrawals or dropouts (Gao 2008; Xie 2006; Xu 1989; Xu 1999; Zhang 1997). None of the studies mentioned allocation concealment. In China, the results of clinical trials are given more importance than the methodology, especially if the methodology is known within the academic circle; so the methodology is not described in detail. We contacted the authors of the included studies by letter to request further data, but we received no response.

 FigureFigure 1. Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.

 

Effects of interventions

See:  Summary of findings for the main comparison Appraisal of the results of Huachansu in the short term for induction of remission in advanced or late gastric cancer;  Summary of findings 2 Appraisal of the results of Aidi in the short term for induction of remission in advanced or late gastric cancer;  Summary of findings 3 Appraisal of the results of Fufangkushen in the short term for induction of remission in advanced or late gastric cancer;  Summary of findings 4 Appraisal of the results of Shenqifuzheng in the short term for induction of remission in advanced or late gastric cancer

1.1 A total of 448 patients were enrolled in the seven trials of Huachansu for gastric cancer: 226 were randomised to the TCMH Huachansu and 222 to the control intervention. After three to four periods of treatment, 113 of 226 patients responded clinically to the Huachansu compared to 89 of 222 who responded to the control intervention. The pooled odds ratio (OR) for clinical complete and partial remission was 1.48 (95% CI 1.01 to 2.17; P = 0.05) using a fixed-effect model and the result was the same using a random-effects model. Toxic and side effects on the digestive system were noted in 78/196 patients in the intervention group compared to 113/192 in the control group. The pooled OR of toxic and side effects on the digestive system was 0.43 (95% CI 0.28 to 0.66; P = 0.0001) using a fixed-effect model and 0.43 (95% CI 0.22 to 0.84; P = 0.01) using a random-effects model. The toxic and side effects of leukopenia were noted in 67/196 patients in the intervention group compared to 112/192 in the control group. The pooled OR for toxic and side effects of leukopenia was 0.32 (95% CI 0.21 to 0.50; P < 0.00001) using a fixed-effect model and 0.32 (95% CI 0.21 to 0.51; P < 0.00001) using a random-effects model.

Sensitivity analyses showed that the result for toxic and side effects on the digestive system was sensitive to change with the random-effects model (risk ratio (RR) 0.82, 95% CI 0.67 to 0.99; P = 0.04) and when the selected patients were in IV stage, the trials included patients with median age > 50 years (RR 0.69, 95% CI 0.49 to 0.97; P = 0.03) using a fixed-effect model, the trials with samples > 60 cases (RR 0.81, 95% CI 0.66 to 0.98; P = 0.03), and the intervention with dosage of Huachansu equal to 20 ml iv gtt qd (RR 0.67, 95% CI 0.53 to 0.84; P = 0.0007) using a random-effects model. Sensitivity analyses showed that the toxic and side effects of leukopenia were sensitive to change with the fixed-effect model (RR 0.62, 95% CI 0.45 to 0.86; P = 0.004) when the selected patients were in stage IV, the trials included patients with median age > 50 years (RR 0.50, 95% CI 0.37 to 0.69; P = 0.0001 using a fixed-effect model; RR 0.52, 95% CI 0.39 to 0.71; P = 0.0001 using a random-effects model), the trials with samples > 60 cases (RR 0.63, 95% CI 0.50 to 0.78; P = 0.001 using a fixed-effect model; RR 0.64, 95% CI 0.49 to 0.83; P = 0.0009 using a random-effects model), and the intervention with dosage of Huachansu equal to 20 ml iv gtt qd (RR 0.67, 95% CI 0.53 to 0.84; P = 0.0005 using a fixed-effect model; RR 0.67, 95% CI 0.50 to 0.89; P = 0.0005 using a random-effects model) ( Table 5). However, due to lack of specific data ( Table 5), it was not possible to analyse changes in the inclusion criteria. Because only the general results were presented in the trials, the results for patients in stage III and stage IV were not available separately.

1.2. The authors of the seven trials did not report on side effects. Four trials (Chen 2009; Wang 2010b; Zhang 2004; Zhang 2005) followed up the patients for 0.5 to two years. Except for Chen 2009, the other trials concluded that there was no statistical difference in life expectancy (MST) between the intervention group and the control group. Zhang 2006 concluded that the patients in the intervention group had improved their QOL and alleviated the cancerous ache following treatment in the short term compared with patients in the control group. Other measures, such as mortality and TTP, were not provided in full so could not be analysed.

2.1. A total of 287 patients were enrolled in the six trials of Aidi for gastric cancer: 145 were randomised to the TCMH Aidi and 142 to the control intervention. After three to four periods of treatment, 76 of 145 patients responded clinically to Aidi compared to 60 of 142 who responded to the control intervention. The pooled OR for clinical complete and partial remission was 1.51 (95% CI 0.94 to 2.41; P = 0.09) using a fixed-effect model and 1.50 (95% CI 0.93 to 2.42; P = 0.09) using a random-effects model. The toxic and side effects on the digestive system were noted in 62/180 patients in the intervention group compared to 100/174 in the control group. The pooled OR of toxic and side effects on the digestive system was 0.33 (95% CI 0.20 to 0.54; P < 0.00001) using a fixed-effect model and 0.33 (95% CI 0.20 to 0.55; P < 0.00001) using a random-effects model. The toxic and side effects of leukopenia were noted in 62/122 patients in the intervention group compared to 81/120 in the control group. The pooled OR for toxic and side effects of leukopenia was 0.43 (95% CI 0.23 to 0.80; P = 0.008) using a fixed-effect model and the same result using a random-effects model.

Sensitivity analyses could not be done for toxic and side effects on the digestive system of patients in stage IV, because no trials only included that kind of patients, but showed that the result for toxic and side effects on the digestive system was sensitive to the change with a random-effects model (RR 0.34, 95% CI 0.20 to 0.58; P < 0.0001) and fixed-effect model (RR 0.33, 95% CI 0.20 to 0.57; P < 0.0001) when the included patients' median age was > 50 years, the trials with samples > 60 cases (RR 0.29, 95% CI 0.15 to 0.57; P = 0.0003) using a random-effects model and the same results using a fixed-effect model, and the intervention with dosage of Aidi equal to 50 ml iv gtt qd (RR 0.37, 95% CI 0.20 to 0.66; P = 0.0008 using a random-effects model; RR 0.36, 95% CI 0.20 to 0.65; P = 0.0006 using a fixed-effect model). Sensitivity analyses could not give results for toxic and side effects of leukopenia in stage IV because no trials only included that kind of patient, but showed that the result for toxic and side effects of leukopenia was sensitive to change with a random effects model (RR 0.46, 95% CI 0.22 to 0.97; P = 0.04) and fixed-effect model (RR 0.46, 95% CI 0.22 to 0.96; P = 0.04) when the included patients' median age was > 50 years, for the trials with samples > 60 cases (RR 0.37, 95% CI 0.17 to 0.83; P = 0.02 using a random-effects model; and the same result using a fixed-effect model), and the intervention with dosage of Aidi equal to 50 ml IV gtt qd (RR 0.46, 95% CI 0.22 to 0.97; P = 0.04 using a random-effects model; and the same result using a fixed-effect model) ( Table 6). However, due to lack of specific data ( Table 6), it was not possible to analyse changes in the inclusion criteria. Because only the general results were presented in the trials, the results for patients in stage III stage and stage IV were not available separately.

2.2. The authors of the six trials did not report on side effects. Only one trial (Gong 2006) followed up the patients for 42 months, and the author concluded that there was no statistical difference in life expectancy (MST) between the intervention group and control group. Chen 2008 and Zhang 2009 concluded that the patients in the intervention group had improved their QOL and alleviated the cancerous ache following treatment in the short term compared with patients in the control group. Other measures, such as mortality and TTP, were not provided and could not be analysed.

3.1. A total of 503 patients were enrolled in the seven trials of Fufangkushen for gastric cancer: 254 were randomised to the TCMH Fufangkushen and 249 to the control intervention. After three to four periods of treatment, 110 of 214 patients responded clinically to Fufangkushen compared to 97 of 209 who responded to the control intervention. The pooled OR for clinical complete and partial remission was 1.22 (95% CI 0.83 to 1.79; P = 0.31) using a fixed-effect model and the result was the same using a random-effects model. The toxic and side effects on the digestive system were noted in 63/153 patients in the intervention group compared to 91/149 in the control group. The pooled OR for toxic and side effects on the digestive system was 0.42 (95% CI 0.26 to 0.69; P = 0.0005) using a fixed-effect model and 0.43 (95% CI 0.26 to 0.69; P = 0.0005) using a random-effects model. The toxic and side effects of leukopenia were noted in 128/254 patients in the intervention group compared to 174/249 treated in the control group. The pooled OR for toxic and side effects of leukopenia was 0.37 (95% CI 0.25 to 0.56; P < 0.0001) using a fixed-effect model and the same results using a random-effects model.

Sensitivity analyses showed that the result for toxic and side effects on the digestive system was sensitive to change from a fixed-effect model to random-effects model (RR 0.35, 95% CI 0.12 to 0.98; P = 0.05) when the selected patients were in IV stage, for the trials with samples > 60 cases (RR 0.42, 95% CI 0.25 to 0.71; P = 0.001), and the intervention with a dosage of Fufangkushen equal to 20 ml iv gtt qd (day 10 to 14) (RR 0.42, 95% CI 0.25 to 0.71; P = 0.001). Sensitivity analyses showed that the result for toxic and side effects of leukopenia was sensitive to change from fixed-effect model to random-effects model (RR 0.36, 95% CI 0.13 to 0.99; P = 0.05) when the selected patients were in IV stage, for the trials with samples > 60 cases (RR 0.37, 95% CI 0.23 to 0.59; P < 0.001), and the intervention with a dosage of Fufangkushen equal to 20 ml (day 10 to 14) iv gtt qd (RR 0.36, 95% CI 0.24 to 0.56; P < 0.0001) ( Table 7). However, due to lack of specific data ( Table 7), it was not possible to analyse changes in the inclusion criteria. Because only the general results were presented in the trials, the results for patients in stage III and stage IV were not available separately.

3.2. The authors of the seven trials did not report on side effects. Only one trial (Zhang 2010) followed up the patients for 0.5 to two years, and they concluded that there was no statistical difference in life expectancy (MST) between the intervention group and control group. Lin 2011 and Zhang 2006 concluded that the patients in the intervention group had improved their QOL and alleviated the cancerous ache following treatment in the short term compared with patients in the control group. Other measures such as mortality and TTP were not provided and could not be analysed.

4.1. A total of 153 patients were enrolled in the three trials of Shenqifuzheng for gastric cancer: 78 were randomised to the TCMH Shenqifuzheng and 75 to the control intervention. After three to four periods of treatment, 46 of 78 patients responded clinically to Shenqifuzheng compared to 37 of 75 who responded to the control intervention. The pooled OR for clinical complete and partial remission was 1.48 (95% CI 0.78 to 2.81; P = 0.23) using a fixed-effect model and the result was the same using a random-effects model. The toxic and side effects on the digestive system were noted in 30/78 patients in the intervention group compared to 31/75 in the control group. The pooled OR for toxic and side effects on the digestive system was 0.90 (95% CI 0.48 to 1.67; P = 0.74) using a fixed-effect model and the same using a random-effects model. The toxic and side effects of leukopenia were noted in 20/78 patients in the intervention group compared to 35/75 in the control group. The pooled OR for toxic and side effects of leukopenia was 0.37 (95% CI 0.18 to 0.74; P = 0.005) using a fixed-effect model and the same using a random-effects model.

Sensitivity analyses showed that the result for toxic and side effects on the digestive system was sensitive to the change in the fixed-effect model and random-effects model (RR 11.40, 95% CI 2.12 to 61.25; P = 0.005) when the selected patients were in IV stage, for the trials with included patients' median age > 50 years (RR 1.63, 95% CI 0.72 to 3.69; P = 0.24 using a fixed-effect model; and RR 2.26, 95% CI 0.11 to 48.60; P = 0.60 using a random-effects model), the trials with samples > 60 cases (RR 0.34, 95% CI 0.12 to 0.98; P = 0.05 using a fixed-effect model and a random-effects model), and the intervention with dosage of Shenqifuzheng equal to 250 ml (day 10 to 14) iv gtt qd (RR 1.63, 95% CI 0.72 to 3.69; P = 0.24 using a fixed-effect model; and RR 2.26, 95% CI 0.11 to 48.60; P = 0.60 using a random-effects model). Sensitivity analyses showed that the result for toxic and side effects of leukopenia was sensitive to change in the fixed-effect model and random-effects model (RR 0.32, 95% CI 0.07 to 1.44; P = 0.14) when the selected patients were in IV stage, for the trials with included patients' median age > 50 years (RR 0.38, 95% CI 0.14 to 1.02; P = 0.05), the trials with samples > 60 cases (RR 0.35, 95% CI 0.12 to 0.97; P = 0.04), and the intervention with dosage of Shenqifuzheng equal to 250 ml (day 10 to 14) iv gtt qd (RR 0.38, 95% CI 0.14 to 1.02; P = 0.05) ( Table 8). However, due to lack of specific data ( Table 8), it was not possible to analyse changes in the inclusion criteria. Because only the general results were presented in the trials, the results for patients in stage III stage and stage IV were not available separately.

4.2. The authors of the three trials did not report on side effects. No trials followed up the patients, and no trials concluded that there was a statistical difference in life expectancy (MST) between the intervention group and control group. Two trials (Luo 2011; Wang 2010) concluded that the patients in the intervention group had improved their QOL and alleviated the cancerous ache following treatment in the short term compared with patients in the control group. Other measures such as mortality and TTP were not provided and could not be analysed.

In the other 57 trials, the different intervention measures prevented pooling of data in a meta-analysis, and subgroup analysis on the herbs could not be performed. There were four types of clinical trials included: formulas of TCMHs with western medicine versus the same western medicine in the intervention group (type I group, 42 trials), western medicine with formulas of TCMHs versus the same formulas of TCMHs (type II group, six trials), formulas of TCMHs versus another formula of TCMHs (type III group, two trials), formulas of TCMHs versus western medicine (type IV group, seven trials).

 

Type I (TCMHs with western medicine versus the same western medicine)

 

Mortality

In the 42 trials, which could not be pooled for meta-analysis, three trials showed a significant difference in mortality at one year between the intervention group and the control group, and the comparison result was the following:13 patients had died in the intervention group (30 patients) and 20 patients in the control group (28 patients) (Chen 1997;  Analysis 5.1) (RR 0.61, 95% CI 0.38 to 0.97); 10 patients had died in the intervention group (77 patients) and 26 patients in the control group (46 patients) (Sun 1999;  Analysis 5.4) (RR 0.23, 95% CI 0.12 to 0.43); 67 patients had died in the intervention group (90 patients) and 20 patients in the control group (40 patients) (Wang 2002;  Analysis 5.5) (RR 1.49, 95% CI 1.07 to 2.08).

Three trials showed a significant difference in mortality at two years between the intervention group and the control group, and the comparison result was the following:13 patients had died in the intervention group (57 patients) and 20 patients in the control group (46 patients) (Wu 1999;  Analysis 5.6) (RR 0.52, 95% CI 0.29 to 0.94). There was no significant difference in mortality at three years and five years, the comparison result was the following, respectively: 38 patients had died in the intervention group (57 patients) and 38 patients in the control group (46 patients) (Wu 1999;  Analysis 5.7) (RR 0.81, 95% CI 0.64 to 1.01); 50 patients had died in the intervention group (57 patients) and 43 patients in the control group (46 patients) (Wu 1999;  Analysis 5.8) (RR 0.94, 95% CI 0.83 to 1.07).

One trial showed no significant difference in mortality at one year between the intervention group and the control group, and the comparison result was the following: 26 patients had died in the intervention group (50 patients) and 23 patients in the control group (40 patients) (Guo 1989;  Analysis 5.3) (RR 0.90, 95% CI 0.62 to 1.32).

Three trials showed no significant difference in mortality at six months between the intervention group and the control group, and the comparison result was the following: five patients had died in the intervention group (32 patients) and 10 patients in the control group (30 patients) (Wu 2000;  Analysis 5.9) (RR 0.47, 95% CI 0.18 to 1.21). There was a significant difference in mortality at one year and two years, the comparison results were the following, respectively: 10 patients had died in the intervention group (32 patients) and 21 patients in the control group (30 patients) (Wu 2000;  Analysis 5.10) (RR 0.45, 95% CI 0.25 to 0.79); 21 patients had died in the intervention group (32 patients) and 27 patients in the control group (30 patients) (Wu 2000;  Analysis 5.11) (RR 0.73, 95% CI 0.55 to 0.96).

Another trial showed no significant difference in mortality at six months and one year between the intervention group and the control group, and the comparison result was the following, respectively: 12 patients had died in the intervention group (51 patients) and 12 patients in the control group (45 patients) (Xu 1993;  Analysis 5.12) (RR 0.88, 95% CI 0.44 to 1.76); 19 patients had died in the intervention group (51 patients) and 22 patients in the control group (45 patients) (Xu 1993;  Analysis 5.13) (RR 0.76, 95% CI 0.48 to 1.21). There was a significant difference in mortality at two years, the comparison result was the following: 25 patients had died in the intervention group (51 patients) and 32 patients in the control group (45 patients) (Xu 1993;  Analysis 5.14) (RR 0.69, 95% CI 0.49 to 0.96).

 

Quality of life (QOL) (< six months)

Of the 42 individual trials, 11 trials showed a significant difference in Karnofsky score (> 60 points) between the intervention group and the control group after the trial, and the comparison result was the following: 21 patients kept their score > 60 points in the intervention group (30 patients) compared with 11 patients in the control group (28 patients) at two months (Chen 1997;  Analysis 5.15) (RR 1.78, 95% CI 1.06 to 2.99). Twenty-seven patients kept their score > 60 points in the intervention group (31 patients) compared with 16 patients in the control group (28 patients) at one month (Huang 2002;  Analysis 5.19) (RR 1.52, 95% CI 1.08 to 2.16). Nineteen patients had increased their score (an increase > 10 points) in the intervention group (35 patients) compared with 7 patients in the control group (33 patients) at six weeks (Li 2002;  Analysis 5.20) (RR 2.56, 95% CI 1.24 to 5.28). Twelve patients had increased their score (an increase > 10 points) in the intervention group (38 patients) compared with three patients in the control group (36 patients) at nine weeks (Liu 2006;  Analysis 5.21) (RR 3.79, 95% CI 1.16 to 12.33). Twenty-seven patients had increased their score (an increase > 10 points) in the intervention group (48 patients) compared with seven patients in the control group (34 patients) at nine weeks (Lv 1999;  Analysis 5.23) (RR 2.73, 95% CI 1.35 to 5.53). Twenty-five patients had increased their score (an increase > 10 points) in the intervention group (31 patients) compared with 10 patients in the control group at three months (31 patients) (Si 2004;  Analysis 5.24) (RR 2.50, 95% CI 1.46 to 4.28). Twenty-eight patients had increased their score (an increase > 10 points) in the intervention group (38 patients) compared with 13 patients in the control group (30 patients) at three months (Wang 2004;  Analysis 5.27) (RR 1.70, 95% CI 1.08 to 2.67). Twenty-four patients had increased their score (an increase > 10 points) in the intervention group (32 patients) compared with 18 patients in the control group (36 patients) at six to eight weeks (Wu 2000a;  Analysis 5.29) (RR 1.50, 95% CI 1.02 to 2.20). Twenty-four patients had increased their score (an increase > 10 points) in the intervention group (30 patients) compared with 16 patients in the control group (30 patients) four weeks after the therapeutic period (Zhu 2005;  Analysis 5.32) (RR 1.50, 95% CI 1.03 to 2.19). The Karnofsky score was 83.33 ± 6.18 (30 patients) in the intervention group and 77.94 ± 6.14 months (30 patients) in the control group at six to nine weeks (Hu 2011) (WMD 5.39, 95% CI 2.27 to 8.51); the Karnofsky score was 85.26 ± 4.21 (36 patients) in the intervention group and 71.19 ± 4.38 (36 patients) in the control group at 15 days (Zhang 2008) (WMD 14.07, 95% CI 12.09 to 16.05).

Eleven trials showed no significant difference in Karnofsky score (> 60 points) between the intervention group and the control group, and the comparison result was the following:

  1. 56 patients had kept their score > 60 points in the intervention group (64 patients) and 52 patients in the control group (64 patients) at three months (Chen 2005;  Analysis 5.16) (RR 1.08, 95% CI 0.93 to 1.25);
  2. 30 patients had kept their score > 60 points in the intervention group (61 patients) and 8 patients in the control group (30 patients) at three months (Hua 1999;  Analysis 5.18) (RR 1.84, 95% CI 0.97 to 3.52);
  3. 16 patients had increased their score (an increase > 10 points) in the intervention group (30 patients) and 12 patients in the control group (30 patients) at six weeks (Liu 2006a;  Analysis 5.22) (RR 1.33, 95% CI 0.77 to 2.31);
  4. 35 patients had increased their score (an increase > 10 points) in the intervention group (77 patients) and 13 patients in the control group (46 patients) at three months (Sun 1999;  Analysis 5.25) (RR 1.61, 95% CI 0.95 to 2.71);
  5. 22 patients had increased their score (an increase > 10 points) in the intervention group (90 patients) and 9 patients in the control group (40 patients) at 9 to 12 weeks (Wang 2002;  Analysis 5.26) (RR 1.09, 95% CI 0.55 to 2.14);
  6. 18 patients had increased their score (an increase > 10 points) in the intervention group (32 patients) and 12 patients in the control group (30 patients) at six to eight weeks (Wu 2000;  Analysis 5.28) (RR 1.41, 95% CI 0.82 to 2.40);
  7. 78 patients had increased their score (an increase > 10 points) in the intervention group (90 patients) and 65 patients in the control group (82 patients) at 12 weeks (Xie 2006;  Analysis 5.30) (RR 1.09, 95% CI 0.95 to 1.25);
  8. 11 patients had increased their score (an increase > 10 points) in the intervention group (40 patients) and 2 patients in the control group (30 patients) at two months (Xu 1999;  Analysis 5.31) (RR 4.13, 95% CI 0.99 to 17.24);
  9. 20 patients had increased their score (an increase > 10 points) in the intervention group (40 patients) and 14 patients in the control group (40 patients) at four weeks (Zhu 2006;  Analysis 5.33) (RR 1.25, 95% CI 0.77 to 2.04).
  10. The Karnofsky score was 77.50 ± 11. 73 (40 patients) in the intervention group and 72.00 ± 11.39 months (40 patients) in the control group at six weeks (Du 2010;  Analysis 5.20) (MD 5.50, 95% CI 0.43 to 10.57);
  11. 15 patients had increased their score (an increase > 10 points) in the intervention group (24 patients) and 12 patients in the control group (23 patients) at three months (Gao 2008;  Analysis 5.3) (RR 1.53, 95% CI 0.48 to 4.89).

 

Rate of short-term remission

Of the 37 individual trials, nine trials showed a significant difference in the rate of short-term remission between the intervention group and the control group after the trial, and the comparison result was the following:

  1. 18 patients in the intervention group (30 patients) and 9 patients in the control group (28 patients) at six weeks (Chen 1997;  Analysis 5.34) (RR 1.87, 95% CI 1.01 to 3.44);
  2. 26 patients in the intervention group (38 patients) and 15 patients in the control group (36 patients) at nine weeks (Liu 2006;  Analysis 5.41) (RR 1.64, 95% CI 1.05 to 2.56);
  3. 45 patients in the intervention group (60 patients) and 31 patients in the control group (60 patients) at 40 days (Niu 2006;  Analysis 5.44) (RR 1.45, 95% CI 1.09 to 1.93);
  4. 24 patients in the intervention group (31 patients) and 15 patients in the control group (31 patients) at nine weeks (Si 2004;  Analysis 5.45) (RR 1.60, 95% CI 1.06 to 2.41);
  5. 17 patients in the intervention group (30 patients) and 6 patients in the control (30 patients) group at 45 days (Wang 1993;  Analysis 5.47) (RR 2.83, 95% CI 1.30 to 6.19);
  6. 23 patients in the intervention group (40 patients) and 11 patients in the control (40 patients) group at eight weeks (Yang 2005;  Analysis 5.55) (RR 2.09, 95% CI 1.18 to 3.69);
  7. 30 patients in the intervention group (35 patients) and 17 patients in the control group (35 patients) at four to six weeks (Zhang 1997;  Analysis 5.56) (RR 1.76, 95% CI 1.12 to 2.55);
  8. 21 patients in the intervention group (28 patients) and 10 patients in the control group (22 patients) at six to eight weeks (Zheng 1999;  Analysis 5.58) (RR 1.65, 95% CI 1.00 to 2.73).

Twenty trials showed no significant difference in the rate of short-term remission between the intervention group and the control group after the trial, and the comparison result was the following:

  1. 42 patients in the intervention group (64 patients) compared with 34 patients in the control group (64 patients) at three months (Chen 2005;  Analysis 5.35) (RR 1.24, 95% CI 0.92 to 1.65);
  2. 20 patients in the intervention group (61 patients) compared with 4 patients in the control group (30 patients) at three months (Hua 1999;  Analysis 5.37) (RR 2.46, 95% CI 0.92 to 6.56);
  3. 9 patients in the intervention group (31 patients) compared with 5 patients in the control group (28 patients) at four weeks (Huang 2002;  Analysis 5.38) (RR 1.63, 95% CI 0.62 to 4.27);
  4. 15 patients in the intervention group (34 patients) compared with 10 patients in the control group (34 patients) at nine weeks (Huang 2005;  Analysis 5.39) (RR 1.50, 95% CI 0.79 to 2.86);
  5. 14 patients in the intervention group (30 patients) compared with 11 patients in the control group (30 patients) at six weeks (Liu 2006a;  Analysis 5.42) (RR 1.27, 95% CI 0.69 to 2.33);
  6. 20 patients in the intervention group (48 patients) compared with 13 patients in the control group (34 patients) (treatment period unspecified) (Lv 1999;  Analysis 5.43) (RR 1.09, 95% CI 0.63 to 1.88);
  7. 20 patients in the intervention group (77 patients) compared with 29 patients in the control group (49 patients) (treatment period unspecified) (Sun 1999;  Analysis 5.46) (RR 0.44, 95% CI 0.28 to 0.68);
  8. 42 patients in the intervention group (90 patients) compared with 15 patients in the control group (40 patients) at three months (Wang 2002;  Analysis 5.48) (RR 1.24, 95% CI 0.79 to 1.97);
  9. 22 patients in the intervention group (38 patients) compared with 10 patients in the control group (30 patients) at 30 to 90 days (Wang 2004;  Analysis 5.49) (RR 1.74, 95% CI 0.98 to 3.08);
  10. 11 patients in the intervention group (24 patients) compared with 7 patients in the control group (22 patients) at 8 to 12 weeks (Wang 2004a;  Analysis 5.50) (RR 1.44, 95% CI 0.68 to 3.05);
  11. 16 patients in the intervention group (32 patients) compared with 12 patients in the control group (30 patients) at six to eight weeks (Wu 2000;  Analysis 5.51) (RR 1.25, 95% CI 0.71 to 2.19);
  12. 12 patients in the intervention group (32 patients) compared with 16 patients in the control group (36 patients) at six to eight weeks (Wu 2000a;  Analysis 5.50) (RR 0.84, 95% CI 0.47 to 1.50);
  13. 52 patients in the intervention group (90 patients) compared with 40 patients in the control group (82 patients) at six weeks (Xie 2006;  Analysis 5.51) (RR 1.19, 95% CI 0.89 to 1.57);
  14. 28 patients in the intervention group (40 patients) compared with 14 patients in the control group (30 patients) at six weeks (Xu 1999;  Analysis 5.52) (RR 1.50, 95% CI 0.97 to 2.31);
  15. 28 patients in the intervention group (40 patients) compared with 14 patients in the control group (40 patients) at six weeks (Zhang 2005a;  Analysis 5.53) (RR 1.23, 95% CI 0.75 to 2.00);
  16. 7 patients in the intervention group (40 patients) compared with 6 patients in the control group (40 patients) at six weeks (Du 2010) (RR 1.20, 95% CI 0.37 to 3.95);
  17. 13 patients in the intervention group (24 patients) compared with 11 patients in the control group (23 patients) at three months (Gao 2008) (RR 1.29, 95% CI 0.41 to 4.06);
  18. 16 patients in the intervention group (30 patients) compared with 13 patients in the control group (30 patients) at six to nine weeks (Hu 2011) (RR 1.31, 95% CI 0.47 to 3.61);
  19. 10 patients in the intervention group (22 patients) compared with 8 patients in the control group (23 patients) at eight weeks (Zhang 2010a) (RR 1.56, 95% CI 0.47 to 5.19);
  20. 25 patients in the intervention group (40 patients) compared with 23 patients in the control group (40 patients) at four weeks (Deng 2011;  Analysis 5.57) (RR 1.23, 95% CI 0.50 to 3.02).

 

Median survival time (MST)

Of the 42 individual trials, only one trial presented the entire data, which showed a significant difference in the MST between the intervention group and the control group. The comparison results were the following: the MST was 24.9 ± 1.36 months (40 patients) in the intervention group and 13.7 ± 0.72 months (40 patients) in the control group (Zhu 2006;  Analysis 5.59) (WMD 11.20, 95% CI 10.72 to 11.68).

 

Time to progression (TTP)

Of the 42 individual trials, no trial presented specific data on TTP so it could not be appraised.

 

Adverse events

 
Life threatening

No trial reported adverse events which were life threatening and no patients died of adverse events.

 
Toxic response

Of the 42 individual trials, the common toxic responses included gastrointestinal side effects (such as nausea, vomiting, abdominal pain, diarrhoea, etc), leukopenia, thrombopenia caused by arrest of bone marrow, damage of liver or kidney function, phlebitis, etc. Eighteen trials reported severe adverse events, including leukopenia in 11 trials, thrombopenia in nine trials, diarrhoea in three trials, decrease of haemoglobin in five trials, nausea and vomiting in 10 trials, damage to liver or kidney function in six trials.

 
Leukopenia

Five trials with specific data showed a significant difference in leukopenia between the intervention group and the control group, and the comparison result was the following: 3 patients in the intervention group (38 patients) compared with 11 patients in the control group (30 patients) (Wang 2004;  Analysis 5.61) (RR 0.29; 95% CI 0.10 to 0.85). The average score for leukopenia in the intervention group (24 patients) was 3.85 ± 0.57 compared with 3.37 ± 0.47 in the control group (23 patients) (Gao 2008) (RR 0.48, 95% CI 0.18 to 0.78); 8 patients in the intervention group (30 patients) compared with 16 patients in the control group (30 patients) at six to nine weeks (Hu 2011) (RR 0.32, 95% CI 0.11 to 0.94); 8 patients in the intervention group (22 patients) compared with 18 patients in the control group (23 patients) at eight weeks (Zhang 2010a) (RR 0.16, 95% CI 0.04 to 0.59). The leukocyte score was 5.39 ± 1.07 (40 patients) in the intervention group and 3.39 ± 1.08 months (40 patients) in the control group at four weeks (Deng 2011) (WMD 2.00, 95% CI 1.53 to 2.47).

Three trials with specific data showed no significant difference in leukopenia between the intervention group and the control group, and the comparison result was the following:

  1. 4 patients in the intervention group (51 patients) compared with 12 patients in the control group (45 patients) (Xu 1993;  Analysis 5.62) (RR 0.31, 95% CI 0.10 to 1.01);
  2. 5 patients in the intervention group (35 patients) compared with 18 patients in the control group (35 patients) (Zhang 1997;  Analysis 5.63) (RR 0.28, 95% CI 0.12 to 0.67).

 
Nausea or vomiting

One trial with specific data showed a significant difference in nausea and vomiting between the intervention group and the control group, and the comparison result was the following: 0 patients in the intervention group (31 patients) compared with 12 patients in the control group (28 patients) (Huang 2002;  Analysis 5.66) (RR 0.04, 95% CI 0.00 to 0.59).

Four trials with specific data showed no significant difference in nausea and vomiting between the intervention group and the control group, and the comparison result was the following:

  1. 6 patients in the intervention group (61 patients) compared with 7 patients in the control group (30 patients) (Hua 1999;  Analysis 5.65) (RR 0.42, 95% CI 0.16 to 1.14);
  2. 1 patient in the intervention group (35 patients) compared with 4 patients in the control group (33 patients) (Li 2002;  Analysis 5.67) (RR 0.24, 95% CI 0.03 to 2.00);
  3. 4 patients in the intervention group (51 patients) compared with 9 patients in the control group (45 patients) (Xu 1993;  Analysis 5.68) (RR 0.39, 95% CI 0.13 to 1.19);
  4. 30 patients in the intervention group (36 patients) compared with 34 patients in the control group (36 patients) (Zhang 2008) (RR 0.29, 95% CI 0.06 to 1.57);
  5. 5 patients in the intervention group (30 patients) compared with 12 patients in the control group (30 patients) (Fu 2011) (RR 0.30, 95% CI 0.09 to 1.00);
  6. 12 patients in the intervention group (22 patients) compared with 19 patients in the control group (23 patients) (Zhang 2010a) (RR 0.25, 95% CI 0.06 to 0.99).

 
Thrombopenia

One trial with specific data showed no significant difference in thrombopenia between the intervention group and the control group, and the comparison result was the following: 2 patients in the intervention group (30 patients) compared with 1 patient in the control group (30 patients) (Wang 1993; Figure 74) (RR 2.00, 95% CI 0.19 to 20.90).

Four trials with specific data showed a significant difference in thrombopenia between the intervention group and the control group, and the comparison result was the following: 3 patients in the intervention group (30 patients) compared with 10 patients in the control group (30 patients) (Hu 2011) (RR 0.22, 95% CI 0.05 to 0.91); the platelet score was 3.89 ± 0.47 (24 patients) in the intervention group and 3.74 ± 0.54 (23 patients) in the control group (Gao 2008) (MD 0.15, 95% CI -0.14 to 0.44); the platelet score was 132.85 ± 22.45 (40 patients) in the intervention group and 119.58 ± 30.52 (40 patients) in the control group (Deng 2011;  Analysis 5.69) (MD 13.27, 95% CI 1.53 to 25.01); 4 patients in the intervention group (22 patients) compared with 11 patients in the control group (23 patients) (Zhang 2010a;  Analysis 5.70) (RR 2.00, 95% CI 0.19 to 20.90).

 
Diarrhoea

One trial with specific data showed no significant difference in diarrhoea between the intervention group and the control group, and the comparison result was the following:

  1. 25 patients in the intervention group (36 patients) compared with 31 patients in the control group (36 patients) (Zhang 2008) (RR 0.37, 95% CI 0.11 to 1.19).

 
Decrease of haemoglobin

One trial with specific data showed no significant difference in the decrease of haemoglobin between the intervention group and the control group, and the comparison result was the following:

  1. 4 patients in the intervention group (30 patients) compared with 3 patients in the control group (30 patients) (Wang 1993;  Analysis 5.74) (RR 1.33, 95% CI 0.33 to 5.45).

Two trials with specific data showed a significant difference in the decrease of haemoglobin between the intervention group and the control group, and the comparison result was the following:

  1. haemoglobin score was 114.25 ± 30.42 (40 patients) in the intervention group and 98.38 ± 26.35 (40 patients) in the control group (Deng 2011) (MD 15.87, 95% CI 3.40 to 28.34);
  2. haemoglobin score was 2.45 ± 0.51 (24 patients) in the intervention group and 1.95 ± 0.42 (23 patients) in the control group (Gao 2008) (MD 0.50, 95% CI 0.23 to 0.77).

 
Damage to liver or kidney function, or both

Four trials with specific data showed no significant difference in damage to the liver or kidney function between the intervention group and the control group. The comparison result was the following: 3 patients in the intervention group (90 patients) compared with 7 patients in the control group (82 patients) (Xie 2006;  Analysis 5.75) (RR 0.39, 95% CI 0.10 to 1.46); 2 patients in the intervention group (30 patients) compared with 6 patients in the control group (30 patients) (Hu 2011) (RR 0.29, 95% CI 0.05 to 1.55); 2 patients in the intervention group (22 patients) compared with 8 patients in the control group (23 patients) (Zhang 2010a) (RR 0.19, 95% CI 0.03 to 1.01); 7 patients in the intervention group (22 patients) compared with 15 patients in the control group (23 patients) (Deng 2011) (RR 0.35, 95% CI 0.13 to 1.00).

 
Discontinuation of treatment

Of the 42 individual trials, two trials showed a significant difference in discontinuation due to an adverse event during the therapeutic period between the intervention group and the control group, and the comparison result was the following:

  1. 3 patients in the intervention group (50 patients) compared with 12 patients in the control group (40 patients) (Guo 1989;  Analysis 5.77) (RR 0.20, 95% CI 0.06 to 0.66);
  2. 5 patients in the intervention group (35 patients) compared with 18 patients in the control group (35 patients) (Zhang 1997;  Analysis 5.79) (RR 0.28, 95% CI 0.12 to 0.67).

Two trials showed a significant difference in discontinuation during the therapeutic period between the intervention group and the control group, and the comparison result was the following:

  1. 3 patients in the intervention group (90 patients) compared with 7 patients in the control group (82 patients) (Xie 2006;  Analysis 5.76) (RR 0.39, 95% CI 0.10 to 1.46);
  2. 4 patients in the intervention group (40 patients) compared with 8 patients in the control group (30 patients) (Xu 1999;  Analysis 5.78) (RR 0.38, 95% CI 0.12 to 1.13).

 

Type II (western medicine with TCMHs versus the same TCMHs)

 

Mortality

The six trials could not be pooled for meta-analysis.

One trial showed a significant difference in mortality at six months and one year between the intervention group and the control group, and the comparison result was the following, respectively:

  1. 7 patients had died in the intervention group (30 patients) compared with 9 patients in the control group (30 patients) (Liu 2002;  Analysis 6.5) (RR 0.37, 95% CI 0.18 to 0.74);
  2. 17 patients had died in the intervention group (30 patients) compared with 27 patients in the control group (30 patients) (Liu 2002;  Analysis 6.6) (RR 0.63, 95% CI 0.45 to 0.88).

One trial showed a significant difference in mortality at one year between the intervention group and the control group, and the comparison result was the following: 22 patients had died in the intervention group (105 patients) compared with 22 patients in the control group (58 patients) (Wang 1998;  Analysis 6.1) (RR 0.55, 95% CI 0.34 to 0.91). There was no significant difference at two years and three years between the intervention group and the control group, and the comparison result was the following, respectively: 37 patients had died in the intervention group (105 patients) compared with 26 patients in the control group (58 patients) (Wang 1998;  Analysis 6.2) (RR 0.79, 95% CI 0.53 to 1.61); 67 patients had died in the intervention group (105 patients) compared with 42 patients in the control group (58 patients) (Wang 1998;  Analysis 6.3) (RR 0.88, 95% CI 0.71 to 1.09).

One trial showed no significant difference in mortality at six months between the intervention group and the control group, and the comparison result was the following: 7 patients had died in the intervention group (22 patients) compared with 12 patients in the control group (19 patients) (Chen 1997a;  Analysis 6.4) (RR 0.41, 95% CI 0.19 to 0.86).

 

Quality of life (QOL) (< six months)

Of the six individual trials, only one trial with specific data showed a significant difference in Karnofsky score (> 60 points) between the intervention group and the control group after the trial, and the comparison result was the following: 25 patients in the intervention group (33 patients) compared with 10 patients in the control group (26 patients) at six weeks (Zhao 2005;  Analysis 6.7) (RR 1.97, 95% CI 1.17 to 3.32).

 

Rate of short-term remission

Of the six individual trials, three trials with specific data showed no significant difference in the rate of short-term remission between the intervention group and the control group after the trial, and the comparison result was the following:

  1. 14 patients in the intervention group (22 patients) compared with six patients in the control group (19 patients) at 40 days (Chen 1997a;  Analysis 6.8) (RR 2.02, 95% CI 0.97 to 4.20);
  2. 14 patients in the intervention group (33 patients) compared with 10 patients in the control group (26 patients) at six weeks (Zhao 2005;  Analysis 6.9) (RR 1.10, 95% CI 0.59 to 2.07);
  3. 13 patients in the intervention group (30 patients) compared with 11 patients in the control group (30 patients) at 8 to 12 weeks after the therapeutic period (Liu 2002;  Analysis 6.10) (RR 1.18, 95% CI 0.63 to 2.20).

 

Median survival time (MST)

Of the six individual trials, no trial presented specific data on MST so it could not be appraised.

 

Time to progression (TTP)

Of the six individual trials, no trial presented specific data on TTP so it could not be appraised.

 

Adverse events

 
Life threatening

No trial reported adverse events which were life threatening and no patients died of adverse events.

 
Toxic response

Of the six individual trials, the common severe toxic responses included arrest of bone marrow and gastrointestinal side effects (such as nausea, vomiting, anorexia, etc). Only two trials reported severe adverse events, including arrest of bone marrow in one trial, nausea or vomiting and anorexia in two trials.

 
Arrest of bone marrow

One trial with specific data showed no significant difference in the arrest of bone marrow between the intervention group and the control group, and the comparison result was the following: 1 patient in the intervention group (33 patients) compared with 4 patients in the control group (26 patients) (Zhao 2005;  Analysis 6.12) (RR 0.20, 95% CI 0.02 to 1.66).

 
Nausea or vomiting

One trial with specific data showed no significant difference in nausea and vomiting between the intervention group and the control group, and the comparison result was the following: 0 patients in the intervention group (33 patients) compared with 1 patient in the control group (26 patients) (Zhao 2005;  Analysis 6.11) (RR 0.26, 95% CI 0.01 to 6.24).

 
Discontinuation of treatment

Of the six individual trials, only one trial with specific data showed a significant difference in discontinuation due to adverse events during the therapeutic period between the intervention group and the control group, and the comparison result was the following: 13 patients in the intervention group (116 patients) compared with 32 patients in the control group (124 patients) (Xu 1989;  Analysis 6.13) (RR 0.43, 95% CI 0.24 to 0.79).

 

Type III (TCMH versus another TCMH)

 

Mortality

Two trials could not be pooled for meta-analysis. One trial with specific data showed a significant difference in mortality at six months between the intervention group and the control group, and the comparison result was the following: 7 patients had died in the intervention group (30 patients) compared with 12 patients in the control group (21 patients) (Shi 2004;  Analysis 7.1) (RR 0.41, 95% CI 0.19 to 0.86).

 

Quality of life (QOL) (< six months)

Of the two individual trials, only one trial with specific data showed a significant difference in Karnofsky score (> 60 points) between the intervention group and the control group after the trial, and the comparison result was the following: 16 patients in the intervention group (30 patients) compared with 4 patients in the control group (21 patients) at 60 days (Shi 2004;  Analysis 7.2) (RR 2.80, 95% CI 1.09 to 7.19).

 

Rate of remission (short-term and long-term)

Of the two individual trials, no trial presented specific data on rate of remission so it could not be appraised.

 

Median survival time (MST)

Of the two individual trials, no trial presented specific data on MST so it could not be appraised.

 

Time to progression (TTP)

Of the two individual trials, no trial presented specific data on TTP so it could not be appraised.

 

Adverse events

 
Life threatening

No trial reported life threatening adverse events and no patient died of adverse events.

 
Toxic response

No trial reported a severe toxic response.

 
Discontinuation of treatment

No trial reported the discontinuation of treatment.

 

Type IV (TCMHs versus western medicine)

 

Mortality

Six trials could not be pooled for meta-analysis. One trial showed no significant difference in mortality at one year and three years between the intervention group and the control group, and the comparison result was the following, respectively:

  1. 13 patients had died in the intervention group (41 patients) compared with 17 patients in the control group (31 patients) (Li 2001;  Analysis 8.1) (RR 0.58, 95% CI 0.33 to 1.00);
  2. 35 patients had died in the intervention group (41 patients) compared with 29 patients in the control group (31 patients) (Li 2001;  Analysis 8.2) (RR 0.91, 95% CI 0.78 to 1.07).

One trial showed no significant difference in mortality at 20 months between the intervention group and the control group, and the comparison result was the following: 15 patients had died in the intervention group (24 patients) compared with 8 patients in the control group (12 patients) (Zhou 2000;  Analysis 8.3) (RR 0.94, 95% CI 0.57 to1.56).

One trial showed no significant difference in mortality at one and two years between the intervention group and the control group, and the comparison result was the following, respectively: 7 patients had died in the intervention group (62 patients) and 7 patients in the control group (56 patients) (You 2000; Figure 1) (RR 0.90, 95% CI 0.34 to 2.41); 14 patients had died in the intervention group (62 patients) and 18 patients in the control group (56 patients) (You 2000; Figure 2) (RR 0.70, 95% CI 0.39 to 1.28). There was a significant difference in mortality at three, five, and 10 years between the intervention group and the control group, and the comparison result was the following, respectively: 22 patients had died in the intervention group (62 patients) compared with 32 patients in the control group (56 patients) (You 2000) (RR 0.62, 95% CI 0.41 to 0.93); 38 patients had died in the intervention group (62 patients) compared with 56 patients in the control group (56 patients) (You 2000) (RR 0.62, 95% CI 0.51 to 0.75); 57 patients had died in the intervention group (62 patients) compared with 56 patients in the control group (56 patients) (You 2000) (RR 0.92, 95% CI 0.85 to 1.00).

One trial showed no significant difference in mortality at one, two, three, four, or five years between the intervention group and the control group, and the comparison result was the following, respectively:

  1. 8 patients died in the intervention group (52 patients) compared with 6 patients in the control group (30 patients) (Jiang 1994) (RR 0.77, 95% CI 0.30 to 2.01);
  2. 18 patients died in the intervention group (52 patients) compared with 12 patients in the control group (30 patients) (Jiang 1994) (RR 0.87, 95% CI 0.49 to1.54);
  3. 24 patients died in the intervention group (52 patients) compared with 17 patients in the control group (30 patients) (Jiang 1994) (RR 0.81, 95% CI 0.53 to 1.25);
  4. 32 patients died in the intervention group (52 patients) compared with 22 patients in the control group (30 patients) (Jiang 1994) (RR 0.84, 95% CI 0.62 to 1.14);
  5. 34 patients died in the intervention group (52 patients) compared with 25 patients in the control group (30 patients) (Jiang 1994) (RR 0.78, 95% CI 0.61 to 1.01).

One trial showed no significant difference in mortality at six months and one year between the intervention group and the control group, and the comparison result was the following, respectively: 7 patients had died in the intervention group (39 patients) compared with 8 patients in the control group (39 patients) (Yang 2006) (RR 0.88, 95% CI 0.35 to 2.18); 10 patients had died in the intervention group (39 patients) compared with 17 patients in the control group (39 patients) (Yang 2006) (RR 0.59, 95% CI 0.31 to 1.12). This trial showed a significant difference in mortality at 1.5 years between the intervention group and the control group, and the comparison result was the following: 19 patients had died in the intervention group (39 patients) compared with 28 patients in the control group (39 patients) (Yang 2006) (RR 0.68, 95% CI 0.47 to 0.99).

 

Quality of life (QOL) (< six months)

Of the six individual trials, only two trials with specific data showed a significant difference in Karnofsky score between the intervention group and the control group after the trial, and the comparison result was the following: Karnofsky score 70.26 ± 6.68 (39 patients) in the intervention group compared with 63.84 ± 6.73 in the control group (39 patients) at two to three months (Yang 2006) (WMD 6.42, 95% CI 3.44 to 9.40); 42 patients in the intervention group (52 patients) compared with 9 patients in the control group (30 patients) at 2 months (Jiang 1994) (RR 2.69, 95% CI 1.53 to 4.72); 20 patients in the intervention group (35 patients) compared with 9 patients in the control group (30 patients) at three weeks (Ye 2009) (RR 3.11, 95% CI 1.11 to 8.70); 20 patients in the intervention group (30 patients) compared with 9 patients in the control group (30 patients) at three weeks (Yang 2010) (RR 4.67, 95% CI 1.57 to 13.87).

Another trial with specific data showed no significant difference in Karnofsky score (> 60 points) between the intervention group and the control group after the trial, and the comparison result was the following: 15 patients in the intervention group (41 patients) compared with 6 patients in the control group (31 patients) at 6 months (Li 2001) (RR 1.89, 95% CI 0.83 to 4.31).

 

Rate of short-term remission

Of the seven individual trials, three trials showed a significant difference in the rate of short-term remission between the intervention group and the control group after the trial, and the comparison result was the following: 3 patients in the intervention group (39 patients) compared with 13 patients in the control group (39 patients) at 8 to 12 weeks (Yang 2006) (RR 0.23, 95% CI 0.09 to 0.75); 21 patients in the intervention group (35 patients) compared with 10 patients in the control group (30 patients) at three weeks (Ye 2009) (RR 3.00, 95% CI 1.09 to 8.29); 21 patients in the intervention group (30 patients) compared with 10 patients in the control group (30 patients) at three weeks (Yang 2010) (RR 4.67, 95% CI 1.57 to 13.87).

Four trials with specific data showed no significant difference in the rate of short-term remission between the intervention group and the control group after the trial, and the comparison result was the following:

  1. 16 patients in the intervention group (41 patients) compared with 5 patients in the control group (31 patients) at six months (Li 2001) (RR 2.42, 95% CI 0.99 to 5.89);
  2. 3 patients in the intervention group (24 patients) compared with 2 patients in the control group (12 patients) at two months (Zhou 2000) (RR 0.75, 95% CI 0.14 to 3.90);
  3. 5 patients in the intervention group (62 patients) compared with 6 patients in the control group (56 patients) at four months (You 2000) (RR 0.75, 95% CI 0.24 to 2.33);
  4. 21 patients in the intervention group (52 patients) compared with 16 patients in the control group (30 patients) at two months (Jiang 1994) (RR 0.76, 95% CI 0.47 to1.21).

 

Median survival time (MST)

Of the six individual trials, only two trials presented complete data, which showed a significant difference in the median survival time (MST) between the intervention group and the control group, and the comparison results were the following: the MST was 12.68 ± 8.36 months (41 patients) in the intervention group and 7.01 ± 5.32 months (31 patients) in the control group (Li 2001) (MD 5.67, 95% CI 2.50 to 8.84); the MST was 10.51 ± 2.06 months (39 patients) in the intervention group and 7.38 ± 3.24 months (39 patients) in the control group (Yang 2006) (MD 3.13, 95% CI 1.93 to 4.33).

 

Time to progression (TTP)

Of the six individual trials, no trial presented specific data on TTP so it could not be appraised.

 

Adverse events

 
Life threatening

No trial reported life threatening adverse events and no patient died of adverse events.

 
Toxic response

Of the seven individual trials, only one trial mentioned severe toxic response in the patients of the control group (You 2000) but it could not be appraised due to lack of specific data.

Leukopenia

One trial showed no significant difference in the leukocyte score: 6.1 ± 2.4 (30 patients) in the intervention group and 4.5 ± 2.4 months (30 patients) in the control group at three weeks (Yang 2010) (MD 1.60, 95% CI 0.39 to 2.81).

Thrombopenia

One trial showed no significant difference in the platelet score: 163.9 ± 51.2 (30 patients) in the intervention group and 143.4 ± 49.5 (30 patients) in the control group (Yang 2010) (MD 20.50, 95% CI -4.98 to 45.98).

Decrease of haemoglobin

One trial showed a significant difference in the haemoglobin score: 111.2 ± 17.1 (30 patients) in the intervention group and 101.2 ± 16.8 (30 patients) in the control group (Yang 2010) (MD 10.00, 95% CI 1.42 to 18.58).

 
Discontinuation of treatment

No trial reported discontinuation of treatment.

The outcomes with a statistically significant difference, from the 51 trials, are listed in the 'Additional tables' ( Table 9).

In the 57 trials, follow-up (from 0.5 to 5 years) was carried out in 16 trials (38.1%, 16/42) in the type I group, three trials (50.0%, 3/6) in the type II group, two trials (100.0%, 2/2) in the type III group, and four trials (57.1%, 4/7) in the type IV group, respectively, but only 13 trials (52%, 13/25) specified the length of follow-up. All the follow-ups supported the conclusion that the TCMHs (with western medicine or not) had better long-term effectiveness (TTP, MST) than the commonly used western medicines for chemotherapy. There were no reports of any toxic effects or side effects of TCMHs and, in fact, one of the curative effects of the TCMHs used in these trials was aimed at the toxic and side effects caused by the chemotherapy itself.

 

Discussion

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Sources of support
  17. Notes
  18. Index terms
 

Summary of main results

Although the recipes for TCM (including TCMHs) have screened some herbs, such as Radix Astragali seu Hedysari, Rhizoma Atractylodis Macrocephalae, Radix Codonopsis Pilosulae, Rhizoma Zedoariae, etc, the effectiveness of TCM for gastric cancer in an advanced or late stage still needs further confirmation by more trials.

Eighty trials with 6857 advanced or late-stage gastric cancer patients were identified. Most trials were of low quality and used TCMHs plus chemotherapy compared with the same chemotherapy alone (65 trials). Others included TCMHs plus western therapeutic methods compared with the same TCMHs (type II, seven trials), TCMHs compared with another TCMH (type III, two trials), and TCMHs compared with western therapeutic methods (type IV, six trials). Except for four trials of Huachansu, six trials of Aidi, seven trials of Fufangkushen, three trials of Shenqifuzheng, we could not pool the other 57 results because no more than two used the same intervention or outcomes.

TCMHs with or without chemotherapy in the 57 trials showed a statistically significant difference for the improvement of mortality in nine trials, quality of life in 16 trials, rate of remission in 11 trials, discontinuation from treatment in three trials, leukopenia in five trials, and vomiting and nausea in one trial. The pooled results from the four injections of TCMHs, Huachansu, Aidi, Fufangkushen, and Shenqifuzheng, showed statistically significant differences for improvement of leukopenia; and Huachansu, Aidi, and Fufangkushen for adverse events in the digestive system; but no significant difference in the rate of short-term remission.

A standard, generally accepted formula of TCM should be used for gastric cancer in an advanced or late stage in large-scale, randomised, double blind and multi-centre trials in China.

 

Overall completeness and applicability of evidence

Although the results, including those of the meta-analysis and description, implied that TCMHs may have some curative effects for advanced or late-stage gastric cancer, obtaining more TTP or MST and fewer toxic and side effects than the commonly used western medicine for chemotherapy mentioned above, it is still too early to draw the conclusion that the TCMHs have definitive curative effects for advanced or late-stage gastric cancer because of the methodological limitations of the data from the trials. Information on allocation concealment, side effects, adverse events, and follow-up have not been provided adequately for research. All of the primary data should be offered for further analyses, regardless of the positive or negative conclusions of the clinical trials.

 

Quality of the evidence

The RCTs should be designed strictly, for example to use the same medicine, same dosage, same course in the controlled group; and when including patients with different levels of illness (stage III or IV) the trial should use stratified randomisation. At the same time, the method of allocation concealment for clinical trials should be clarified by the authors. In the 80 included studies, only seven trials (Chen 2009; Jiang 1994; Liu 2009; Wang 1998; Wang 2004; Zhang 2008; Zhang 2010) mentioned that they used a random number table (or drawing straws, envelope concealment), without any special explanation. An urgent mission in the TCM field for gastric cancer is to change the current reporting practices of the study authors. Even if the method of allocation concealment is clear to some, it should be elucidated completely in the article for the purpose of further analysis.

 

Potential biases in the review process

The journal editors responsible for publication should ask the authors to include information about the methods of the trials and authors should not be permitted to omit these contents. Details of follow-up and adverse events should also be provided, regardless of whether they occurred or not.

It should be noted that although meta-analysis could not be carried out for most of the trials on Huachansu, because most of the trials were not strictly RCTs, the TCMH Huachansu has been used widely for many years in China. The main components of Huachansu include extracts from the skin of the Chinese toad.

 

Agreements and disagreements with other studies or reviews

Because the classical therapeutic regimen for advanced or late-stage gastric cancer is chemotherapy, and almost all of the researchers in TCM circles are aware of this, choosing it as the active comparator in the control group makes the efficacy of TCHMs more convincing than if they had been compared with placebo. The trials were all designed as equivalence trials and no placebo controlled trials were carried out. Some researchers believe their self-made formulas of TCMHs for gastric cancer in an advanced or late stage to be more effective than some patented TCMHs, so in the type II group some commonly used patented medicines of TCMHs were chosen as the active comparators in the control group. Other relevant reviews about TCMHs for breast cancer (Zhang 2007), TCMHs for colorectal cancer (Wu 2008), and TCMHs for lung cancer (Rui 2008) all showed that TCMHs may alleviate the chemotherapy-related side effects or adverse events, but the evidence is too limited to make any confident conclusions. More high quality studies are needed.

 

Authors' conclusions

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Sources of support
  17. Notes
  18. Index terms

 

Implications for practice

This review did not provide assured evidence concerning the effectiveness of TCMHs in improving the quality of life or rate of remission, alleviating the toxic and side effects caused by the chemotherapy, delaying the time to progression, prolonging the median survival times, or reducing short-term mortality. Limited and weak evidence showed that Huachansu, Aidi, Fufangkushen, and Shenqifuzheng, when used together with chemotherapy, improved leukopenia; and Huachansu, Aidi, and Fufangkushen also improved the adverse events in the digestive system caused by chemotherapy but did not improve the rate of short-term remission (complete remission or partial remission). Limitations were due to most of the included studies being of low quality and the scarcity of valid samples. Large, well designed clinical trials are required urgently before any confident conclusions can be drawn about the value of TCMHs for advanced or late-stage gastric cancer.

At present, the general evidence is insufficient to suggest that clinical practice should be changed on the basis of these results.

 
Implications for research

A standardised formula of TCMHs should be developed and used for all trials of advanced or late-stage gastric cancer in China. Data from large, randomised, double blind, multi-centre trials are required to confirm the benefit and safety of TCMHs for treatment of advanced or late-stage gastric cancer. These trials should use standardised outcome measures for efficacy and should include an assessment of adverse events. All the trials should provide adequate follow-up periods so that long-term efficacy and safety can be assessed.

 

Acknowledgements

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Sources of support
  17. Notes
  18. Index terms

We thank Janet Lilleyman, Cathy Bennett and Karin Dearness, Coordinators of the Cochrane UGPD Group, for advice on writing and revising this protocol, and thank the Danish Cancer Society for funding this review.

 

Data and analyses

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Sources of support
  17. Notes
  18. Index terms
Download statistical data

 
Comparison 1. Appraisal of the results of Huachansu in the short term

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 the rate of complete remission and partly remission7448Odds Ratio (M-H, Fixed, 95% CI)1.48 [1.01, 2.17]

 2 the toxic and side effects in digestive system after chemotherapy (no special data in trial of Zhang 2006)6388Odds Ratio (M-H, Fixed, 95% CI)0.43 [0.28, 0.66]

 3 the toxic and side effects of leukopenia after chemotherapy(no special data in trial of Zhang 2006)6388Odds Ratio (M-H, Fixed, 95% CI)0.32 [0.21, 0.50]

 
Comparison 2. Appraisal of the results of Aidi in the short term

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 the rate of complete remission and partly remission(no special data in trial of Zhang 2009)5287Odds Ratio (M-H, Fixed, 95% CI)1.51 [0.94, 2.41]

 2 the toxic and side effects in digestive system after chemotherapy6354Odds Ratio (M-H, Fixed, 95% CI)0.33 [0.20, 0.54]

 3 the toxic and side effects of leukopenia after chemotherapy(no special data in trial of Jia 2003, Zhang 2009)4242Odds Ratio (M-H, Fixed, 95% CI)0.43 [0.23, 0.80]

 
Comparison 3. Appraisal of the results of Fufangkushen in the short term

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 the rate of complete remission and partly remission(no special data in trial of Fu 2011)6423Odds Ratio (M-H, Fixed, 95% CI)1.22 [0.83, 1.79]

 2 the toxic and side effects in digestive system after chemotherapy(no special data in trial of Fu 2011, Liu 2009a, Zhang 2010)4302Odds Ratio (M-H, Fixed, 95% CI)0.42 [0.26, 0.69]

 3 the toxic and side effects of leukopenia after chemotherapy7503Odds Ratio (M-H, Fixed, 95% CI)0.37 [0.25, 0.56]

 
Comparison 4. Appraisal of the results of Shenqifuzheng in the short term

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 the rate of complete remission and partly remission3153Odds Ratio (M-H, Fixed, 95% CI)1.48 [0.78, 2.81]

 2 the toxic and side effects in digestive system after chemotherapy3153Odds Ratio (M-H, Random, 95% CI)1.13 [0.18, 7.24]

 3 the toxic and side effects of leukopenia after chemotherapy3153Odds Ratio (M-H, Fixed, 95% CI)0.37 [0.18, 0.74]

 
Comparison 5. Appraisal of the results of type I

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 mortality 11Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 2 mortality 31Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 3 mortality 41Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 4 mortality 51Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 5 mortality 6-21Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 6 mortality 6-11Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 7 mortality 6-31Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 8 mortality 7-11Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 9 mortality 7-21Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 10 mortality 7-31Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 11 mortaliyt 8-11Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 12 mortality 8-21Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 13 mortality 8-31Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 14 quality of life 11Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 15 qualitiy of life 21Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 16 quality of life 41Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 17 quality of life 51Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 18 quality of life 61Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 19 quality of life 71Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 20 quality of life 81Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 21 quality of life 91Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 22 quality of life 101Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 23 quality of life 111Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 24 quality of life 121Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 25 quality of life 131Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 26 quality of life 141Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 27 quality of life 151Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 28 quality of life 161Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 29 quality of life 171Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 30 quality of life 181Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 31 quality of life 191Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 32 quality of life 20180Mean Difference (IV, Fixed, 95% CI)5.5 [0.43, 10.57]

 33 quality of life 21147Odds Ratio (M-H, Fixed, 95% CI)1.53 [0.48, 4.89]

 34 quality of life 22160Mean Difference (IV, Fixed, 95% CI)5.39 [2.27, 8.51]

 35 quality of life 23172Mean Difference (IV, Fixed, 95% CI)14.07 [12.09, 16.05]

 36 rate of remission 11Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 37 rate of remission 21Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 38 rate of remission 41Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 39 rate of remission 51Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 40 rate of remission 61Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 41 rete of remission 81Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 42 rate of remission 91Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 43 rate of remission 101Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 44 rate of remission 111Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 45 rate of remission 121Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 46 rate of remission 131Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 47 rate of remission 141Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 48 rate of remission 151Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 49 rate of remission 161Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 50 rate of remission 171Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 51 rate of remission 181Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 52 rate of remission 191Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 53 rate of remission 201Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 54 rate of remission 211Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 55 rate of remission 221Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 56 rate of remission 231Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 57 rate of remission 241Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 58 rate of remission 251Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 59 rate of remission 26180Odds Ratio (M-H, Fixed, 95% CI)1.20 [0.37, 3.95]

 60 rate of remission 27147Odds Ratio (M-H, Fixed, 95% CI)1.29 [0.41, 4.06]

 61 rate of remission 28160Odds Ratio (M-H, Fixed, 95% CI)1.31 [0.47, 3.61]

 62 rate of remission 29145Odds Ratio (M-H, Fixed, 95% CI)1.56 [0.47, 5.19]

 63 rate of remission 30180Odds Ratio (M-H, Fixed, 95% CI)1.23 [0.50, 3.02]

 64 median survival times 11Mean Difference (IV, Fixed, 95% CI)Totals not selected

 65 leukopenia 21Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 66 leukopenia 31Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 67 leukopenia 41Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 68 leukopenia 5147Mean Difference (IV, Fixed, 95% CI)0.48 [0.18, 0.78]

 69 leukopenia 6160Odds Ratio (M-H, Fixed, 95% CI)0.32 [0.11, 0.94]

 70 leukopenia 7145Odds Ratio (M-H, Fixed, 95% CI)0.16 [0.04, 0.59]

 71 leukopenia 8180Mean Difference (IV, Fixed, 95% CI)2.00 [1.53, 2.47]

 72 nausea/vomiting 21Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 73 nausea/vomiting 31Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 74 nausea/vomiting 41Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 75 nausea/vomiting 51Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 76 nausea/vomiting 6172Odds Ratio (M-H, Fixed, 95% CI)0.29 [0.06, 1.57]

 77 nausea/vomiting 7160Odds Ratio (M-H, Fixed, 95% CI)0.3 [0.09, 1.00]

 78 nausea/vomiting 8145Odds Ratio (M-H, Fixed, 95% CI)0.25 [0.06, 0.99]

 79 thrombopenia 11Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 80 thrombopenia 2160Odds Ratio (M-H, Fixed, 95% CI)0.22 [0.05, 0.91]

 81 thrombopenia 3147Mean Difference (IV, Fixed, 95% CI)0.15 [-0.14, 0.44]

 82 thrombopenia 4145Odds Ratio (M-H, Fixed, 95% CI)0.24 [0.06, 0.94]

 83 thrombopenia 5180Mean Difference (IV, Fixed, 95% CI)13.27 [1.53, 25.01]

 84 diarrhea 1172Odds Ratio (M-H, Fixed, 95% CI)0.37 [0.11, 1.19]

 85 decrease of hemoglobin 11Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 86 decrease of hemoglobin 2180Mean Difference (IV, Fixed, 95% CI)15.87 [3.40, 28.34]

 87 decrease of hemoglobin 3147Mean Difference (IV, Fixed, 95% CI)0.50 [0.23, 0.77]

 88 damage of liver and/or kidney function 11Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 89 damage of liver and/or kidney function 2160Odds Ratio (M-H, Fixed, 95% CI)0.29 [0.05, 1.55]

 90 damage of liver and/or kidney function 3145Odds Ratio (M-H, Fixed, 95% CI)0.19 [0.03, 1.01]

 91 damage of liver and/or kidney function 4180Odds Ratio (M-H, Fixed, 95% CI)0.35 [0.13, 1.00]

 92 discontinuation due to adverse event 11Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 93 discontinuation due to adverse event 21Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 94 discontinuation due to adverse event 31Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 95 discontinuation due to adverse event 41Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 
Comparison 6. Appraisal of the results of type II

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 mortality 1.11Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 2 mortality 1.21Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 3 mortality 1.31Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 4 mortality 21Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 5 mortality 3.11Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 6 mortality 3.21Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 7 quality of life 11Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 8 rate of remission 11Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 9 rate of remission 21Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 10 rate of remission 31Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 11 nausea/vomiting 11Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 12 arrest of bone marrow1Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 13 discontinuation due to adverse event1Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 
Comparison 7. Appraisal of the results of type III

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 mortality1Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 2 quality of life1Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 
Comparison 8. Appraisal of the results of type IV

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 mortality 1.11Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 2 mortality 1.21Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 3 mortality 21Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 4 mortality 3.11Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 5 mortality 3.21Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 6 mortality 3.31Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 7 mortality 3.41Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 8 mortality 3.51Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 9 mortality 4.11Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 10 mortality 4.21Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 11 mortality 4.31Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 12 mortality 5.11Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 13 mortality 5.21Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 14 mortality 5.31Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 15 mortality 5.41Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 16 mortality 5.51Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 17 quality of life 11Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 18 quality of life 21Mean Difference (IV, Fixed, 95% CI)Totals not selected

 19 quality of life 31Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 20 quality of life 4165Odds Ratio (M-H, Fixed, 95% CI)3.11 [1.11, 8.70]

 21 quality of life 5160Odds Ratio (M-H, Fixed, 95% CI)4.67 [1.57, 13.87]

 22 rate of remission 11Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 23 rate of remission 21Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 24 rate of remission 31Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 25 rate of remission 41Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 26 rate of remission 51Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 27 rate of remission 6165Odds Ratio (M-H, Fixed, 95% CI)3.0 [1.09, 8.29]

 28 rate of remission 7160Odds Ratio (M-H, Fixed, 95% CI)4.67 [1.57, 13.87]

 29 Leukopenia 1160Mean Difference (IV, Fixed, 95% CI)1.60 [0.39, 2.81]

 30 Thrombopenia 1160Mean Difference (IV, Fixed, 95% CI)20.5 [-4.98, 45.98]

 31 Decrease of haemoglobin 1160Mean Difference (IV, Fixed, 95% CI)10.0 [1.42, 18.58]

 32 median survival time 11Mean Difference (IV, Fixed, 95% CI)Totals not selected

 33 median survival time 21Mean Difference (IV, Fixed, 95% CI)Totals not selected

 
Comparison 9. Sensitivity analyses for Huachansu

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 the rate of complete remission and partly remission only for trials with patients in IV stage4246Risk Ratio (M-H, Fixed, 95% CI)1.15 [0.83, 1.58]

 2 the toxic and side effects in digestive system only for trials with patients in IV stage(no special data in trial of Zhang 2006)3186Risk Ratio (M-H, Fixed, 95% CI)0.84 [0.68, 1.05]

 3 the toxic and side effects of leukopenia only for trials with patients in IV stage(no special data in trial of Zhang 2006)3186Risk Ratio (M-H, Random, 95% CI)0.52 [0.24, 1.12]

 4 the rate of complete remission and partly remission only for trials with patients' median age>50 years old5295Risk Ratio (M-H, Random, 95% CI)1.29 [1.02, 1.62]

 5 the toxic and side effects in digestive system only for trials with patients' median age>50 years old(no special data in trial of Zhang 2006)4235Risk Ratio (M-H, Random, 95% CI)0.72 [0.40, 1.30]

 6 the toxic and side effects of leukopenia only for trials with patients' median age>50 years old(no special data in trial of Zhang 2006)4235Risk Ratio (M-H, Random, 95% CI)0.52 [0.39, 0.71]

 7 the rate of complete remission and partly remission only for trials with samples>605348Risk Ratio (M-H, Fixed, 95% CI)1.23 [0.99, 1.54]

 8 the toxic and side effects in digestive system only for trials with samples>60(no special data in trial of Zhang 2006)4288Risk Ratio (M-H, Fixed, 95% CI)0.62 [0.50, 0.77]

 9 the toxic and side effects of leukopenia only for trials with samples>60(no special data in trial of Zhang 2006)4288Risk Ratio (M-H, Random, 95% CI)0.64 [0.49, 0.83]

 10 the rate of complete remission and partly remission only for trials with dosage of injectio Huachansu=20ml iv gtt Qd4281Risk Ratio (M-H, Fixed, 95% CI)1.24 [0.98, 1.57]

 11 the toxic and side effects in digestive system only for trials with dosage of injectio Huachansu=20ml iv gtt Qd3221Risk Ratio (M-H, Random, 95% CI)0.62 [0.32, 1.20]

 12 the toxic and side effects of leukopenia only for trials with dosage of injectio Huachansu=20ml iv gtt Qd3221Risk Ratio (M-H, Fixed, 95% CI)0.67 [0.53, 0.84]

 
Comparison 10. Sensitivity analyses for Aidi

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 the rate of complete remission and partly remission only for trials with patients' median age>50 years old(no special data in trial of Zhang 2009)4227Odds Ratio (M-H, Random, 95% CI)1.68 [0.98, 2.88]

 2 the toxic and side effects in digestive system only for trials with patients' median age>50 years old5294Odds Ratio (M-H, Fixed, 95% CI)0.33 [0.20, 0.57]

 3 the toxic and side effects of leukopenia only for trials with patients' median age>50 years old3182Odds Ratio (M-H, Fixed, 95% CI)0.46 [0.22, 0.96]

 4 the rate of complete remission and partly remission only for trials with samples>=602130Odds Ratio (M-H, Random, 95% CI)1.23 [0.61, 2.49]

 5 the toxic and side effects in digestive system only for trials with samples>=603197Odds Ratio (M-H, Fixed, 95% CI)0.29 [0.15, 0.57]

 6 the toxic and side effects of leukopenia only for trials with samples>=602130Odds Ratio (M-H, Fixed, 95% CI)0.37 [0.17, 0.83]

 7 the rate of complete remission and partly remission only for trials with dosage of injectio Adi=50ml iv gtt Qd (day12˜21)3182Odds Ratio (M-H, Random, 95% CI)1.88 [1.03, 3.43]

 8 the toxic and side effects in digestive system only for trials with dosage of injectio Aidi=50ml iv gtt Qd(day12˜21)4249Odds Ratio (M-H, Fixed, 95% CI)0.36 [0.20, 0.65]

 9 the toxic and side effects of leukopenia only for trials with dosage of injectio Aidi=50ml iv gtt Qd(day12˜21)3182Odds Ratio (M-H, Random, 95% CI)0.46 [0.22, 0.97]

 
Comparison 11. Sensitivity analyses for Fufangkushen

 
Comparison 12. Sensitivity analyses for Shenqifuzheng

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 the rate of complete remission and partly remission only for trials with patients in IV stage143Odds Ratio (M-H, Random, 95% CI)1.31 [0.39, 4.39]

 2 the toxic and side effects in digestive system only for trials with patients in IV stage143Odds Ratio (M-H, Fixed, 95% CI)11.40 [2.12, 61.25]

 3 the toxic and side effects of leukopenia only for trials with patients in IV stage143Odds Ratio (M-H, Fixed, 95% CI)0.32 [0.07, 1.44]

 4 the rate of complete remission and partly remission only for trials with patients' median age>50 years old291Odds Ratio (M-H, Random, 95% CI)1.49 [0.65, 3.42]

 5 the toxic and side effects in digestive system only for trials with patients' median age>50 years old291Odds Ratio (M-H, Fixed, 95% CI)1.63 [0.72, 3.69]

 6 the toxic and side effects of leukopenia only for trials with patients' median age>50 years old291Odds Ratio (M-H, Random, 95% CI)0.38 [0.14, 1.02]

 7 the rate of complete remission and partly remission only for trials with samples>60162Odds Ratio (M-H, Random, 95% CI)1.47 [0.54, 4.00]

 8 the toxic and side effects in digestive system only for trials with samples>60162Odds Ratio (M-H, Random, 95% CI)0.34 [0.12, 0.98]

 9 the toxic and side effects of leukopenia only for trials with samples>60162Odds Ratio (M-H, Fixed, 95% CI)0.35 [0.12, 0.97]

 10 the rate of complete remission and partly remission only for trials with dosage of injectio Shenqifuzheng=250ml iv gtt Qd(day10˜14)291Odds Ratio (M-H, Fixed, 95% CI)1.49 [0.65, 3.42]

 11 the toxic and side effects in digestive system only for trials with dosage of injectio Shenqifuzheng=250ml iv gtt Qd(day10˜14)291Odds Ratio (M-H, Fixed, 95% CI)1.63 [0.72, 3.69]

 12 the toxic and side effects of leukopenia only for trials with dosage of injectio Shenqifuzheng=250ml iv gtt Qd(day10˜14)291Odds Ratio (M-H, Random, 95% CI)0.38 [0.14, 1.02]

 

Appendices

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Sources of support
  17. Notes
  18. Index terms
 

Appendix 1. CENTRAL search strategy

#1 MeSH descriptor Phytotherapy explode all trees in MeSH
#2 MeSH descriptor Drugs, Chinese Herbal explode all trees in MeSH
#3 MeSH descriptor Medicine, Herbal explode all trees in MeSH
#4 MeSH descriptor Plants, Medicinal explode all trees in MeSH
#5 MeSH descriptor Medicine, Traditional explode all trees
#6 ((traditional or chinese or oriental or alternative or complementary) and medicine*) or herb* or plant* ?
#7 (#1 OR #2 OR #3 OR #4 OR #5 OR #6)
#8 MeSH descriptor Gastric cancer explode all trees
#9 Gastric cancer
#10 (#8 OR #9)
#11 (#7 AND #10)

 

Appendix 2. MEDLINE search strategy

1. exp Medicine, Traditional/
2. exp Drugs, Chinese Herbal/
3. exp Medicine, Herbal/
4. exp Phytotherapy/
5. exp Plants, Medicinal/
6. (((traditional or chinese or oriental or alternative or complementary) and medicine*) or herb* or plant*).mp. [mp=title, original title, abstract, name of substance word, subject heading word]
7. 1 or 2 or 3 or 4 or 5 or 6
8. exp Gastric cancer/
9. gastric cancer.mp. [mp=title, original title, abstract, name of substance word, subject heading word]
10. 8 or 9
11. 7 and 10
12. (random* or blind* or placebo* or meta-analysis).mp. [mp=title, original title, abstract, name of substance word, subject heading word]
13. 11 and 12

 

Appendix 3. EMBASE search strategy

1. exp Traditional Medicine/
2. exp Medicinal Plant/
3. Plant Medicinal Product/
4. exp Phytotherapy/
5. (((traditional or chinese or oriental or alternative or complementary) and medicine*) or herb* or plant*).mp. [mp=title, abstract, subject headings, heading word, drug trade name, original title, device manufacturer, drug manufacturer name]
6. 1 or 2 or 3 or 4 or 5
7. exp Gastric cancer/
8. Gastric cancer.mp. [mp=title, abstract, subject headings, heading word, drug trade name, original title, device manufacturer, drug manufacturer name]
9. 8 or 7
10. 6 and 9
11. (random* or blind* or placebo* or meta-analysis).mp. [mp=title, abstract, subject headings, heading word, drug trade name, original title, device manufacturer, drug manufacturer name]
12. 11 and 10

 

Appendix 4. Chinese Bio-Medicine Database

(((traditional OR chinese OR oriental OR alternative OR complementary) AND medicine*) OR herb* OR plant*) AND (Gastric cancer OR Gastric carcinoma OR Gastric tumour)

 

What's new

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Sources of support
  17. Notes
  18. Index terms

Last assessed as up-to-date: 8 October 2011.


DateEventDescription

8 October 2011New search has been performedTwenty-three new trials were identified and incorporated into the meta-analyses.

8 October 2011New citation required but conclusions have not changedTCMHs combined with or without chemotherapy in the 57 trials showed statistically significant difference for the improvement of mortality in 9 trials, quality of life in 16 trials, rate of remission in 11 trials, leukopenia in 5 trials. The pooled results from the four injections of TCMHs, Huachansu, Aidi, Fufangkushen, Shenqifuzheng showed statistically significant difference for the improvement of leukopenia, and Huachansu, Aidi, Fufangkushen for adverse events in the digestive system, but no significant difference of the rate of short-term remission.



 

History

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Sources of support
  17. Notes
  18. Index terms

Protocol first published: Issue 1, 2005
Review first published: Issue 1, 2010


DateEventDescription

4 January 2011AmendedReview withdrawn

21 September 2010AmendedContact details updated.

30 September 2008AmendedConverted to new review format.



 

Contributions of authors

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Sources of support
  17. Notes
  18. Index terms

Linlin Zhu and Jinlin Yang revised the review.

Tao Gan designed and revised previous versions of the review, and controlled the overall quality of the review.

Tao Gan and Zongying Wu wrote the first draft of the review.

Ling Tian and Zongying Wu performed handsearches, retrieved papers, and extracted data.

Yiping Wang conceived the idea for the review and gave some suggestions for the review.

 

Declarations of interest

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Sources of support
  17. Notes
  18. Index terms

None

 

Sources of support

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Sources of support
  17. Notes
  18. Index terms
 

Internal sources

  • Chinese Cochrane Center, Huaxi Hospital of Sichuan University, China.
    Provided the data, information and cost-free search for this review.

 

External sources

  • Danish Cancer Society, Denmark.
    Provided the funding for this review.

 

Notes

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Sources of support
  17. Notes
  18. Index terms

The review was withdrawn in January 2011 due to an outdated literature search.

* Indicates the major publication for the study

References

References to studies included in this review

  1. Top of page
  2. AbstractRésumé
  3. Summary of findings
  4. Background
  5. Objectives
  6. Methods
  7. Results
  8. Discussion
  9. Authors' conclusions
  10. Acknowledgements
  11. Data and analyses
  12. Appendices
  13. What's new
  14. History
  15. Contributions of authors
  16. Declarations of interest
  17. Sources of support
  18. Notes
  19. Characteristics of studies
  20. References to studies included in this review
  21. References to studies excluded from this review
  22. Additional references
Cao 1992 {published data only}
  • Cao Y, Li N, Zhang L, Hua L, Li Z. Clinical observation about association with Western and Traditional Chinese Medicines treating 70 patients with advanced gastric cancer. Clinical Journal of Traditional Chinese Medicine 1992;2(3):8-9.
Cao 1997 {published data only}
  • Cao J, Xiao X, Tang X. Observation of effect about Elemene plus fluorouracil and acupuncturing Shenque treat advanced gastric carcinoma. Chinese Clinic of Oncology 1997;24(7):549-50.
Chen 1997 {published data only}
  • Chen N, Jin Y, Lai Y. Observation of effect Pingxiao capsule combined chemotherapy treats advanced gastric cancer. Straits Pharmacy 1997;9(1):66-7.
Chen 1997a {published data only}
  • Chen N, Jin Y, Liu Y, Chen Y. Observation of effect about hydroxycamptothecin combined with Chinese medicine treating advanced gastric carcinoma of 41 cases. Fujian Journal of Medicine 1997;19(2):82.
Chen 2005 {published data only}
  • Chen P, Gao H, Song J, Zheng W. ELF connected with Cidan capsule treat gastric carcinoma of 64 cases. Chinese Clinic of Oncology 2005;32(8):466-7.
Chen 2008 {published data only}
  • Chen NJ, Wu DH, Lai YQ, Chen YY. Combining AIDI and FOLFOX4 treated advanced gastric cancer. Guangming Journal of Chinese Medicine 2008;23(11):1768-9.
Chen 2009 {published data only}
  • Chen HM. The effect of Huachansu with TPF regimen for late gastric cancer. Journal of Emergency in Traditional Chinese Medicine 2009;18(1):35-6.
Deng 2001 {published data only}
  • Deng W, Guan C. Elemene plus chemotherapy influence on immunity of older progressive gastric carcinoma. Journal of Guangdong Medical College 2001;19(5):350. [: 1005-4057(2001)-05-0350-01]
Deng 2011 {published data only}
  • Deng ZJ, Cao HN, Gao TN. Shenfu Injection with PCF chemotherapy for late or advanced gastric cancer in 40 cases. Contemporary Medicine 2011;17(12):116-8.
Du 2010 {published data only}
  • Du CJ, Wang TL, Guo YS. Clinical observation of quality of life in patients with gastric carcinoma treated by combination of traditional Chinese medicine, chemotherapy and hyperthermia treatment. Hebei Journal of Traditional Chinese Medicine 2010;32(9):1299-301.
Fu 2011 {published data only}
  • Fu JW, Deng Y, Huang W. Compound matrine injection with chemotherapy in the treatment of pain from advanced or late gastric cancer in 40 patients. Journal of Emergency in Traditional Chinese Medicine 2011;20(1):152-3.
Gao 2008 {published data only}
  • Gao P, Fang XH, Zhang Q, Yang F, Yang ZB, Zhang XC, et al. Clinical Random Control Study on Advanced Gastric Cancer with Mijisan Granule Infusion Combined with FLO Plan. Journal of Zhejiang Chinese Medicine College 2008;32(6):756-8.
Gong 2006 {published data only}
  • Gong L, Jiang C, Zhao Y. Aidi combining with chemotherapy treat progressive gastric carcinoma. Journal of Oncology 2006;12(5):424-5.
Guan 2001 {published data only}
  • Guan C, He G, Yin Z. Effect of elemene emulsion combined chemotherapy on immunity of gastric cancer patients in progressive stage. Chinese Clinic of Oncology 2001;28(2):123-4. [: 1000-8179(2001)-02-0123-02]
Guo 1989 {published data only}
  • Guo L, Chen G. Observation of efficacy about association with Western and Traditional Chinese Medicines treats 90 patients with advanced gastric carcinoma. Fujian Medicine Journal 1999;11(1):19-20.
Hu 2011 {published data only}
  • Hu Y, Hou AJ, Zhang HW, Huang YL, Gu WF. Clinical observation of Fuzheng Xiao'ai prescription I combined with OFL regimen for treatment advanced gastric cancer. Journal of New Chinese Medicine 2011;43(2):104-6.
Hua 1999 {published data only}
  • Hua B, Wang A, Hou W. Clinical study on treatment of mid-late stage gastric carcinoma by composite Xiansu capsule combined with chemotherapy. Journal of Combination of Traditional Chinese Medicine with Western Medicine 1999;19(8):470-3.
Huang 2002 {published data only}
  • Huang Z, Si Z, Luo Y, Huang N. Clinical efficacy of Toad Venom injection combined with chemotherapy in treating 31 patients with medium and advanced gastric cancer. Hebei Journal of Traditional Chinese Medicine 2002;24(3):163-5.
Huang 2005 {published data only}
  • Huang X, Song A. Clinical research on elemene combined chemotherapy treating gastric cancer. Chinese Traditonal Medicine 2005;5(3):40-1.
Jia 2003 {published data only}
  • Jia L, Zhu S, Li P, Zhang K, Wan D, Cai G, et al. Therapeutic effect observation about Aidi, Cisplatin and Fluorouracil treating gastric carcinoma. Journal of China Oncology 2003;25(5):517.
Jia 2009 {published data only}
  • Jia JW, Liu YQ. The effect of Shenqi Fuzheng injection combined with FOLFOX4 regimen in the treatment of advanced gastric cancer. The Practical Journal of Cancer 2009;24(3):273-5.
Jiang 1994 {published data only}
  • Jiang Y. Clinical observation about invigorating the spleen and removing cancer ingredient treating advanced gastric carcinoma 52 cases. Human Journal of Traditional Chinese Medicine 1994;10(4):3-5.
Li 2001 {published data only}
  • Li X, Wei P. Effect observation about Jinlongshe for oral use treating advanced gastric carcinoma. Hubei Journal of Traditional Chinese Medicine 2001;23(11):3-5.
Li 2002 {published data only}
  • Li S, He L, Song Y. A clinical report of Yiqihuoxue Recipe combinating with FAP regimen for improving the living qualities in patients with gastric cancer in advanced or late stage. Journal of Sichuan of Traditional Chinese Medicine 2002;20(12):33-4.
Lin 2011 {published data only}
  • Lin CL, Ge JH. Clinical research of gastric cancer at the late stage treated with Compound Spophora Flavescens injection combined with chemotherapy. World Journal of Integrated Traditional and Western Medicine 2011;6(4):316-8.
Liu 2002 {published data only}
  • Liu Y, Zhou J. Association with Western and Traditional Chinese Medicines treats 30 patients with advanced gastric cancer. Journal of Shandong Traditional Chinese Medicine 2002;21(3):164-5. [: 0257-358X(2002)03-0164-02]
Liu 2006 {published data only}
  • Liu H, Zeng B, Xu L. Observation of decoction of eight ingredients combined with chemotherapy treating advanced gastric carcinoma. Modern Journal of Integrated Traditional Chinese and Western Medicine 2006;15(24):3366.
Liu 2006a {published data only}
  • Liu J, Hu D, Fan H, Niu L. Clinical observation of Tianlong treating advanced gastric cancer of 30 cases. Hebei Traditional Chinese Medicine 2006;28(10):739-40. [: 1002-2619(2006)10-739-02]
Liu 2009 {published data only}
  • Liu LH, Zhang CX. Clinical efficacy of Aidi injection combined with TPF in the treatment of advanced gastric carcinoma. China Modern Doctor 2009;47(29):16-7.
Liu 2009a {published data only}
  • Liu SL, Ding C, Gu XX. Compound matrine injection with chemotherapy in the treatment of 29 patients with advanced gastric cancer. Chinese Journal of Coal Industry Medicine 2009;12(10):1566-7.
Luo 2011 {published data only}
  • Luo PF. The effect of Shenqi Fuzheng injection combined with chemotherapy for advanced gastric cancer. Modern Medicine & Health 2011;27(8):1170-1.
Lv 1999 {published data only}
  • Lv B, Yang J. Analysis of efficacy about association Western and Traditional Chinese medicines treating 48 patients with progressive and advanced gastric cancer. Chinese Traditional Treatment 1999;2(2):24-5.
Niu 2006 {published data only}
  • Niu H, Mu Y. Complex prescription of the TCM and chemotherapy treat 120 patients with advanced gastric carcinoma. Shanxi Traditional Chinese Medicine 2006;26(9):1034-5.
Peng 2006 {published data only (unpublished sought but not used)}
  • Peng Z, Zhang Y, Chen M. Strengthing-body-resistance decoction effect on immunity of gastric cancer patients. Liaoning Journal of Traditional Chinese Medicine 2006;33(11):1459. [: 1000-1719(2006)11-1459-01]
Rao 1994 {published data only}
  • Rao F, Yu R, Hu Y, Wang Y, Jin J, Tian Z. Long-term effect observation Shengxuetang combined with chemotherapy treats advanced gastric cancer. Chinese Journal of Traditional Chinese Medicine 1994;14(6):366.
Shao 1998 {published data only}
  • Shao J. clinical study of compound Zhenjian liquid in treating advanced gastric cancer. Journal of Traditional Chinese Medicine 1998;39(8):479-80.
Shi 2004 {published data only}
  • Shi L, Ye Y, Luo S, Chen J, Yan X. Effect on life quality and immune about Huachansu combined with Chinese medical differentiation of symptoms and signs in treating gastric carcinoma. Journal of Zhejiang Chinese Medicine College 2004;28(6):20-1.
Si 2004 {published data only}
  • Si H, Shang G, Lu W. Observation of efficacy about TCM and chemo treating advanced gastric cancer. Jiangsu Journal of Traditional Chinese Medicine 2004;35(258):40-1.
Sun 1999 {published data only}
  • Sun G, Li J. Clinical and experimental research about Qiao-Wei-Kang-Liu dissolved medicines combined with chemotherapy treating advanced gastric cancer. Medical Research Communication 1999;28(6):6-7.
Tian 1999 {published data only}
  • Tian R, Yang J, Zhang B, Li G. Clinical observations of gastric cancer patients treated with chemotherapy and Lanxiangxiru as a MDR mediator treated with chemotherapy and Elemene as a MDR mediator. Cancer Research on Prevention and Treatment 1999;26(3):215-6.
Wang 1993 {published data only}
  • Wang R, Wu D, Jin Y, Chen J, Liu Y, Huang P, et al. The short-term effects of Jianpijiandu Decoction plus chemotherapy for advanced gastric cancer. Fujian Journal of Traditional Chinese Medicine 1993;24(5):23-6.
Wang 1998 {published data only}
  • Wang G, Zhu J, Xu W, Wang Y, Zhou A. Clinical and experimental studies on Fuzheng granula combined with chemotherapy in advanced gastric cancer. World Chinese Journal of Digestology 1998;6(3):214-8. [: ISSN1007-9319 CN 14-1218/R]
Wang 2002 {published data only}
  • Wang X, Wang R, Dai H. Invigorating the spleen and removing cancer ingredient combined with chemotherapy treat older advanced gastric carcinoma of 90 cases. Shandong Journal of Chinese Medicine 2002;21(9):527-8. [: 0257-358X(2002)09-0527-02]
Wang 2004 {published data only}
  • Wang P. Observation effect in chemotherapy, radiotherapy and Yadanzi oil treating advanced gastric carcinoma. Journal of Practical Oncology 2004;19(1):78-9. [: 1001-1692(2004)01-0078-02]
Wang 2004a {published data only}
  • Wang R, Pan Y, Ye Z. Clinical observation about Invigorating the spleen and dissolving petechia mixtura combined with chemotherapy treating advanced gastric carcinoma of 24 cases. Jiangsu Traditional Chinese Medicine 2004;25(11):22-3. [: 1672-397X(2004)11-0022-02]
Wang 2009 {published data only}
  • Wang ZL, Shen HL, Zhou G, Li ZY. The effects of Aidi injection to assist selective infusion chemotherapy in treatment of advanced gastric cancer. Journal of Zhejiang Chinese Medical University 2009;33(2):219-20.
Wang 2009a {published data only}
  • Wang YH. The effect of Huachansu with chemotherapy for advanced or late gastric cancer. Jaingxi Journal of Traditional Chinese Medicine 2009;40(4):31-2.
Wang 2010 {published data only}
  • Wang JF. The effect of Shenqi Fuzheng injection combined with chemotherapy and radiotherapy for local advanced gastric cancer. Chinese Journal of Traditional Medical Science and Technology 2010;17(6):537-8.
Wang 2010a {published data only}
  • Wang J, Wang KM, Wang ZX, Lu BB, Li J. Compound matrine injection combined with DCF chemotherapy in the treatment of 25 patients with advanced gastric carcinoma. Chinese Journal of New Drugs 2010;19(17):1585-8.
Wang 2010b {published data only}
  • Wang WM, Li CF, Yao RJ. The clinical effect of Huachansu with chemotherapy for late gastric cancer. Clinical Journal of Traditional Chinese Medicine 2010;22(4):314-5.
Wu 1999 {published data only}
  • Wu Y, Cai M, Zhu X. Following up of 5 years about Western and Chinese Traditional Medicines treating advanced gastric cancer. Journal of Nanjing University of Traditional Chinese Medicine 1999;15(2):124.
Wu 2000 {published data only}
  • Wu Y. Analysis of the therapeutic effect of Fuzhenggongjian capsule on the late gastric carcinoma under chemotherapy. Journal of Zhengjiang Medical College 2000;10(4):656-7.
Wu 2000a {published data only}
  • Wu C, Li Q, Zhao Y, Li Q. Controlled observation on Elemene plus chemotherapy treating advanced gastric cancer. Journal of North Sichuan Medical College 2000;15(3):12-3. [: 1005-3697(2000)03-0012-02]
Xie 2006 {published data only}
  • Xie C. Observation of effect Lailikang granula combined with chemotherapy treat advanced gastric carcinoma. Modern Medicine 2006;22(6):882-3. [: 1009-5519(2006)-06-0882-02]
Xiong 2008 {published data only}
  • Xiong LG. Clinical observation of Yanshu injection combined with paclitaxel and oxaliplatin in the treatment of advanced gastric cancer. The Practical Journal of Cancer 2008;23(3):276-7.
Xu 1989 {published data only}
  • Xu Y. The effects of Yangxue decoction plus chemotherapy for late gastric cancer after operation. Journal of Practical Oncology 1989;3(1):54-6.
Xu 1993 {published data only}
  • Xu D, Zhang X. Clinical observation about Ai-Fu-Kang plus chemotherapy treating patients with progressive gastric cancer after operation. Shanxi Traditional Chinese Medicine 1993;9(4):14.
Xu 1999 {published data only}
  • Xu Y. Clinical efficacy study Fuzhenghuoxue combined with chemotherapy in treating advanced gastric cancer. Hebei Journal of Traditional Chinese Medicine 1999;21(6):329-31.
Yang 2005 {published data only}
  • Yang Z, Yuan X, Li G. Shenfu combining with ELFP treat advanced gastric carcinoma of 40 cases. Chinese Medical Science Study 2005;18(7):26-7.
Yang 2006 {published data only}
  • Yang Z, You J. No 3 readjust of Chinese medicine treat advanced gastric carcinoma by differentiation of symptoms and signs. Liaoning Journal of Traditional Chinese Medicine 2006;33(11):1434-5. [: 1000-1719(2006)11-1434-02]
Yang 2010 {published data only}
  • Yang SP, Du B. The effect of Shenqi Fuzheng injection for advanced or late gastric cancer in old patients. Chinese Community Doctors 2010;12:87.
Ye 2009 {published data only}
  • Ye SF, Ye B, Wu M. The effect of Shenqi Fuzheng injection for advanced or late gastric cancer in old patients. Journal of Wenzhou Medical College 2009;39(2):172-3.
You 2000 {published data only}
  • You J, Zhao J. Readjusting and balancing methods of doctor Zhao treat advanced gastric cancer of 176 cases. Jilin Traditional Chinese Medicine 2000;20(5):10-11.
You 2005 {published data only}
  • You J, Zhao J, Zhou L. Clinical study about Fuzhenghewei in treating fourth stage gastric cancer. Jiangsu Chinese Medicine 2005;26(11):11-3.
Zhang 1997 {published data only}
  • Zhang F. Clinic research that Shengyutang treats adverse reaction after advanced gastric cancer patients receive chemotherapy. Journal of Changchun College of Traditional Chinese Medicine 1997;13(61):18.
Zhang 2001 {published data only}
  • Zhang C, Wang Q. Huachansu combined with chemotherapy treat advanced 35 cases of gastric carcinoma. Journal of Anhui Traditional Chinese Medicine College 2001;20(4):18-9. [: 1000-2219(2001)-04-0018-01]
Zhang 2004 {published data only}
  • Zhang R, Chen C, Shen B, Zhou D, Zhang G. Clinical observation of Huachansu combined with chemotherapy treating advanced gastric carcinoma. Chinese Clinical Oncology 2004;9(3):269-70. [: 1009-0460(2004)-03-0269-02]
Zhang 2005 {published data only}
  • Zhang Y, Zhu M, Cao T, Zhang P, Yao L, Huang H. Observation of curative effect of Huachansu combined with chemotherapy treating progressive and advanced gastric carcinoma. Henan Journal of Oncology 2005;18(5):359-60. [: 1003-1464(2005)05-0359-02]
Zhang 2005a {published data only}
  • Zhang J, Wang H, Zhang Y. Jinlong capsule combined with HFL treat advanced gastric carcinoma. Capital Medicine 2005;9(23):33.
Zhang 2006 {published data only}
  • Zhang Z, Wang Y, Rong D. Late effect of Huachansu combined with hydroxy. Practical Journal of Medicine and Pharmaceuticals 2006;23(7):794-5.
Zhang 2008 {published data only}
  • Zhang H, Su ZX. Curative effect of Shenling Baizhu powder on chemotherapy-induced toxicity in advanced gastric cancer. Journal of TCM University of Hunan 2008;28(2):51-3, 56.
Zhang 2009 {published data only}
  • Zhang AX. Aidi injection with chemotherapy for advanced or late gastric cancer. Journal of Medical Theory & Practice 2009;22(10):1214.
Zhang 2010 {published data only}
  • Zhang JJ, Wei JH, Wei S, Wei AF, Lan C, Zhang F'E. ECF with compound injection of radix sophorae flavescentis for late gastric cancer in 32 patients. Guangji Medical Journal 2010;32(5):533-5.
Zhang 2010a {published data only}
  • Zhang L, Wang YF. The effect and immune function of Kanglaite with chemotherapy for advanced or late gastric cancer. Acta Universitatis Medicinalis Nanjin (Natural Science) 2010;30(11):1657-9.
Zhang 2010b {published data only}
  • Zhang MJ, Zuo CF. Observation of clinical efficacy of Yanshu injection combined with NP chemotherapy in treatment of advanced gastric cancer. Chinese Journal of Clinical Oncology and Rehabilitation 2010;17(6):531-3.
Zhao 2005 {published data only}
  • Zhao Z, Liao Z, Zhao X. The clinic research of the effect of Sheng Mai injection combined with the chemotherapy in the elderly patients with advanced gastric cancer. Modern Oncology 2005;13(3):387-8. [: 1672-4992(2005)03-387-02]
Zheng 1999 {published data only}
  • Zheng L, Sun K. Research of efficacy about Western and Traditional Chinese Medicines treating progressing and advanced gastric cancer. Heilongjiang Medicine and Pharmacy 1999;22(1):86-7.
Zhou 2000 {published data only}
  • Zhou R, Wu L, Ni A, Xu Z. Clinical observation of intravenous drip of "Anti-inflammation1" in treating 24 patients with mid and late gastric carcinoma. Shanghai Journal of Traditional Chinese Medicine 2000;34(8):15-6. [: 1007-1334(2000)08-0015-02]
Zhu 2005 {published data only}
  • Zhu H, Zhu Z, Xu L. White Powder of Three Ingredients Medicine treats progressive gastric cancer of 30 cases. Journal of Nanjing Traditional Chinese Medicine University 2005;21(5):284-5. [: 1000-5005(2005)05-0284-02]
Zhu 2006 {published data only}
  • Zhu J, Song M, Wang L, Sun Q, Zhu L, Fang C. Immunoregulation and short-term therapeutic effect of super-selective intra-arteral chemotherapy combined with traditional Chinese drugs on gastric cancer patients. Journal of Chinese Integrative Medicine 2006;4(5):478-81.

References to studies excluded from this review

  1. Top of page
  2. AbstractRésumé
  3. Summary of findings
  4. Background
  5. Objectives
  6. Methods
  7. Results
  8. Discussion
  9. Authors' conclusions
  10. Acknowledgements
  11. Data and analyses
  12. Appendices
  13. What's new
  14. History
  15. Contributions of authors
  16. Declarations of interest
  17. Sources of support
  18. Notes
  19. Characteristics of studies
  20. References to studies included in this review
  21. References to studies excluded from this review
  22. Additional references
Ben 2010 {published data only}
  • Ben BJ. The effect of Kang'ai injection with chemotherapy for late gastric cancer in 38 old patients. Shanxi Journal of Traditional Chinese Medicine 2010;31(5):546-7.
Bu 2001 {published data only}
  • Bu X. The effects of Xindekang on apoptosis of advanced stage stomach cancers. Herald of Medicine 2001;20(10):616-7. [: 1004-0781(2001)10-0616-02]
Cao 2010 {published data only}
  • Cao J. The analysis of curative effect of traditional Chinese medicine combined with FOLFOX-4 chemotherapy on treatment for the patients with advanced gastric cancer. Liaoning Journal of Traditional Chinese Medicine 2010;37(3):493-5.
Chen 1997b {published data only}
  • Chen X. Long-term observation of effect about Yi-Ai-San treating advanced gastric cancer. Journal of New Chinese Medicine 1997;29(1):34.
Chen 2004 {published data only}
  • Chen J, Chen Q, Huang Z, Luo X, Zhang Y, Huang X. Therapeutic effect observation about Aidi treating the senior advanced gastric carcinoma of 32 cases. Journal of West China Pharmacy 2004;19(2):157-8.
Chen 2011 {published data only}
  • Chen QS. The effect of Yiqijianpi decoction combined with FOLFOX regimen for advanced or late gastric cancer in 30 patients. Yunnan Journal of Traditional Chinese Medicine and Materia Medica 2011;32(4):45-7.
Cui 2009 {published data only}
  • Cui P. The effect of Huachansu for late gastric cancer. Journal of Liaoning Medical University 2009;30(4):333-4.
Da 2003 {published data only}
  • Da N, Ren D, Shuai S, Guo C, Fu Y, Long D. Efficacy of Yishou Xiaozhen Powder in patients with advanced gastric cancer. Medical Journal of West China 2003;1(1):67-9.
Deng 2003 {published data only}
  • Deng F, Chen Y. Wei-kang combined with CF and 5-Fu treats advanced gastric cancer of 30 cases. Straits Pharmacy 2003;15(1):54. [: 1006-3765(2003)-01-0054-01]
Gao 2003 {published data only}
  • Gao P. Clinical observation of conclusion Huweixiaoji prescription combined with FF207 treating older patient with advanced gastric carcinoma. Journal of Henan University of Chinese Medicine 2003;2(18):35-6. [: 1006-3234(2003)03-0035-02]
Gao 2006 {published data only}
  • Gao S, Wang X, Pan Q. Eight dainties drops combining with enterocoelia chemotherapy treat progressive postoperative gastric carcinoma. Journal of Northern China Coal Medical College 2006;8(2):199-200.
Gao 2011 {published data only}
  • Gao J. Avanica oil joint MF/CF clinical observation of advanced gastric cancer chemotherapy. Medical Journal of Chinese Peoples' Health 2011;23(9):1108-9.
Ge 2010 {published data only}
  • Ge YL. Clinical efficacy of Aidi injection combined with MF/CF in the treatment of advanced gastric carcinoma. Chinese Journal of Ethnomedicine and Ethnopharmacy 2010;19(10):31-2.
Gu 2006 {published data only}
  • Gu W, Jiao J. Clinical observation that Pulse-activating Injection plus chemotherapy treats advanced gastric cancer of 36 cases. New Journal of Traditional Chinese Medicine 2006;38(10):59-60. [: 0256-7415(2006)10-0059-02]
Guo 2003 {published data only}
  • Guo Y, Li Y, Huang L, Jiao Z. Clinical study of compound Xuanju capsules combined with chemotherapy in treating moderate and advanced gastric cancer. Chinese Journal of Integrated Traditional and Western Medicine 2003;23(12):941-2.
Han 2005 {published data only}
  • Han Y, Si P. Clinical observation in chemotherapy combined with herbs treating 30 cases of progressive gastric cancer after operation. Shanxi Journal of Traditional Chinese Medicine 2005;21(2):13. [: 1000-7156(2005)02-0013-01]
He 2010 {published data only}
  • He GJ. The effect of Yiqijianpiyangyin Decoction combined with chemotherapy for advanced or late gastric cancer. Liaoning Journal of Traditional Chinese Medicine 2010;37(12):2400-1.
Hu 2001 {published data only}
  • Hu P. Fuzhenghewei combined with HFC treat gastric cancer of 90 cases. Journal of Nanjing Chinese Medicine University 2001;17(5):274.
Hu 2009 {published data only}
  • Hu PP. The effect of Fuzhenghewei Decoction with OLF therapeutic regimen for late gastric caner in 30 patients. Shanxi Journal of Traditional Chinese Medicine 2009;30(1):6-7.
Hu 2010 {published data only}
  • Hu PP, Wang WS, Xue Q. The effect of Jianpisanjie Decoction with FOLFOX regimen for late gastric cancer in 28 patients. Journal of New Chinese Medicine 2010;42(6):76-7.
Huang 2002a {published data only}
  • Huang Z, Li H, Zhang Z, Tan Z, Lu Y, Chen C, et al. Jianpixiaojitang combined with chemotherapy treat advanced gastric carcinoma of 30 cases. Shanxi Journal of Traditional Chinese Medicine 2002;18(4):35-6. [: 1000-7156(2002)04-0035-02]
Huang 2008 {published data only}
  • Huang XN, You JL. The effect of Weitiao III with paclitaxel for advanced or late gastric cancer. Journal of Liaoning University of Traditional Chinese Medicine 2008;10(11):113-4.
Huang 2009 {published data only}
  • Huang ZF, Liu JB, Li HZ, Huang CJ. Effect of combination of Fufang Ku Shen Zhusheye and chemotherapy for treatment of 30 advanced gastric cancer patients. West China Medical Journal 2009;24(11):2883-5.
Huo 2009 {published data only}
  • Huo Y, Cheng G. The effect of Xiao'aiping combined with chemotherapy for advanced or late gastric cancer. Chinese Community Doctors 2009;11(18):138.
Jiang 2011 {published data only}
  • Jiang H. The effect of traditional Chinese medicine with western medicine for advanced or late gastric cancer. Heilongjiang Journal of Traditional Chinese Medicine 2011;53(1):8.
Jiao 2001 {published data only}
  • Jiao G, Zhou C, Xu G, Chen B, Sun C. The clinical research on Curcum in and chlorophyll on auxiliary therapy to gastric cancer. Acta Nutrinenta Sinica 2001;23(3):237-8.
Ke 2010 {published data only}
  • Ke YF, Yi J. The effect of Aidi injectio with chemotherapy for late gastric cancer. Public Medical Forum Magazine 2010;14:1107-8.
Lai 2010 {published data only}
  • Lai YQ, Chen NJ, Wu DH, Yu JP. The clinical effect of self-made Jianpiyishen Decoction with chemotherapy for late gastric cancer in 25 patients. Fujian Journal of Traditional Chinese Medicine 2010;41(5):18-9.
Li 2006 {published data only}
  • Li R. Clinical observation about Yan-Shu injection combined with chemotherapy treating mild and advanced gastric cancer. Chinese Community Doctor 2006;8(16):60.
Li 2006a {published data only}
  • Li H, Pan L. Clinical research about TCM and neoadjuvant chemotherapy treating progressive gastric cancer. Jiangsu Traditional Chinese Medicine 2006;27(3):25-7. [: 1672-397x(2006)03-0025-03]
Li 2008 {published data only}
  • Li XY. 58 Cases of late gastric cancer treated with decoction for stomach cancer. Journal of Henan University of Chinese Medicine 2008;23(2):50, 52.
Li 2011 {published data only}
  • Li ZQ. The effect of Shenlingbaizhusan with chemotherapy for late gastric cancer in 27 patients. Shanxi Journal of Traditional Chinese Medicine 2011;32(1):4-6.
Liu 1999 {published data only}
  • Liu X, Zhou M, Xu F, Lu Y. Jinkehuaier granula combined with FAM treat advanced gastric carcinoma of 38 cases. Zhejiang Oncology 1999;5(3):189.
Liu 2002a {published data only}
  • Liu Y, He J. Clinical observation about No3 Kangwei combined with chemotherapy treating advanced gastric carcinoma. Journal of Shandong University of Traditional Chinese Medicine 2002;26(6):444. [: 1007-659x(2002)06-0444-01]
Liu 2003 {published data only}
  • Liu B, Wang L, Zhou H, Qian H. Clinical observation of Huishengtai capsule treating advanced gastric carcinoma. Journal of Chengdu University of Traditional Chinese Medicine 2003;26(2):9-11.
Liu 2009b {published data only}
  • Liu TC, Zheng RS, Yu XQ. Clinical study on patients with advanced gastric cancer treated with KangAiPingWan and FED combination chemotherapy. Chinese Journal of General Practice 2009;7(9):921-3.
Liu 2011 {published data only}
  • Liu YH, Huang J, Wang Y, Zheng ZS. The effect of Astragalus polysaccharides injectio with chemotherapy for advanced or late gastric cancer. Journal of Practical Medicine 2011;27(3):516-8.
Lu 1998 {published data only}
  • Lu H, Lin X. Huachansu combined with chemotherapy treating progressing and advanced gastric carcinoma of 70 cases. Practical Journal of Chinese Medicine 1998;11(13):1201.
Lu 2010 {published data only}
  • Lu ZF. Clinical observation of treating gastric cancer with CTM-WM therapy. Chinese Journal of Clinical Rational Drug Use 2010;3(11):20-1.
Luo 2009 {published data only}
  • Luo ZY. The effect of traditional Chinese Medicine with chemotherapy for advanced or late gastric cancer. China Practical Medicine 2009;4(23):163-4.
Mo 2010 {published data only}
  • Mo YY. A clinical analysis of Kang'ai injection with oxaliplatin, calcium folinate, fluorouracil for advanced or late gastric cancer. Journal of Chinese Practical Diagnosis and Therapy 2010;24(10):1008-9.
Ni 2005 {published data only}
  • Ni M, Chen Z, Peng Y. Clinical study of intraperitoneal chemotherapy plus ShiQuanDaBu Drink on advanced gastric cancer. Chinese Clinical Oncology 2005;10(3):288-90. [: 1009-0460(2005)03-0288-03]
Ni 2010 {published data only}
  • Ni YQ. Effect of combination of traditional Chinese medicine and lentinan on cellular immunity in patients with medium and advanced gastric cancer. Hebei Journal of Traditional Chinese Medicine 2010;32(8):1136-8.
Pan 2009 {published data only}
  • Pan SJ, Yin CC, Feng YL. Clinical observation on Wuzhuyu soup for the treatment of vomit of later gastric cancer of 32 cases. Liaoning Journal of Traditional Chinese Medicine 2009;36(9):1519-20.
Qin 2010 {published data only}
  • Qin ZQ, Lu LQ, Yuan GR, Wu GQ, Xue Q, Zhao TW, et al. Elemene combined OLF program of treatment of advanced gastric cancer. Chinese Archives of Traditional Chinese Medicine 2010;28(2):435-7.
Qiu 1992 {published data only}
  • Qiu J, Jia J, Yang J, Zheng J, Zheng J, Tang L, et al. Investigation of invigorating the spleen in treating advanced gastric carcinoma. Journal of Chinese Medicine 1992;33(8):23-5.
Qu 1997 {published data only}
  • Qu T, Si H. TCM and chemotherapy treat 86 patients with advanced gastric cancer. Fujian Journal of Traditional Chinese Medicine 1997;28(2):1-2.
Qu 2010 {published data only}
  • Qu XY, Yang CZ. The effect of Fupihualiu Decoction for advanced or late gastric cancer in 32 patients. Shanxi Journal of Traditional Chinese Medicine 2010;31(1):9-10.
Ren 2008 {published data only}
  • Ren LX, Wang YH, Ha MH. The clinical effect of Huchansu for late gastric cancer. China Journal of Chinese Materai Medica 2008;33(12):1474-5.
Shi 2010 {published data only}
  • Shi XL, Sun Y, Wang Y, Zhang XX, Han J, Zhou Y. Clinical study on "Changweiqing Liquid" plus chemotherapy in treating advanced gastric cancer of spleen deficiency and phlegm damp stagnation. Shanghai Journal of Traditional Chinese Medicine 2010;44(11):43-5.
Shu 2010 {published data only}
  • Shu P, Wang Z. The inhibition effect of Shenqijianwei Decoction for VEGF-A in late or advanced gastric cancer. Liaoning Journal of Traditional Chinese Medicine 2010;37(10):1969-70.
Shu 2010a {published data only}
  • Shu P. The inhibition effect of Shenqijianwei Decoction for VEGF-C in late or advanced gastric cancer. Shanxi Journal of Traditional Chinese Medicine 2010;31(9):1110-1.
Su 1993 {published data only}
  • Su J, Su D, Li M, Zhang L, Zhou P, Mi K, et al. Study on attenuation effect of A-L tonic drink against UFTM-associated systemic toxicity in patients with advanced gastric cancer. Chinese Oncology Clinic 1993;20(12):929-31.
Sun 2010 {published data only}
  • Sun ZX, Li DG, Lv SJ, Liu JX. The effect of Huazhuojiedu Decoction with chemotherapy for advanced or late gastric cancer in 32 patients. Hebei Journal of Traditional Chinese Medicine 2010;32(9):1305-6.
Tian 2006 {published data only}
  • Tian J. Study of efficacy of Fuzhengkangai combined with chemotherapy in treating advanced gastric cancer. Chinese Civilian Treatment 2006;14(11):16-7.
Tian 2011 {published data only}
  • Tian CT, Han LY. The effect of self-made Jianpiyishen Decoction with chemotherapy for late gastric cancer in 42 patients. Shanxi Journal of Traditional Chinese Medicine 2011;32(5):518-20.
Wang 1996 {published data only}
  • Wang R, Wang J. Clinical observation of Qilong stomach-calming decoction combined with chemotherapy treating advanced gastric cancer. Shandong Journal of Traditional Chinese Medicine 1996;15(6):248-9.
Wang 2003 {published data only}
  • Wang Z, Qing H, Dong G, Wang W. KangLaiTe effects on apoptosis and hyperplasia of gastric cancer cells. Journal of the Fourth Military Medical University 2003;24(4):1. [: 1000-2790(2003)04-&#183;&#226;3-01]
Wang 2004b {published data only}
  • Wang M. Poeder for regulating the function of stomach relieves toxic reaction of EAP treating progressive gastric cancer. Fujian Medical Journal 2004;26(3):128-9. [: 1002-2600(2004)03-0128-02]
Wang 2006 {published data only}
  • Wang D, Zhang L, Li S, Zhang Y. Clinical observation about Traditional Chinese Medicine and chemotherapy treating gastric cancer. Journal of Liaoning University of Traditional Chinese Medicine 2006;8(5):100-1.
Wang 2008 {published data only}
  • Wang LJ, Li XD, Zhang HZ. The effect of Kang'ai Injectio with chemotherapy for late gastric cancer. Chinese Medicine Modern Distance Education of China 2008;6(4):358-9.
Wang 2008a {published data only}
  • Wang X'E, Jiang H, Yang H, Xie GM. The effect of self-made Jianpisanjie Decoction with chemotherapy for late gastric cancer. Zhejiang Journal of Integrated Traditional Chinese and Western Medicine 2008;18(8):500-1.
Wang 2009b {published data only}
  • Wang YQ, Shi YL, Shi YY. The effect of Shaolifoshoukunbu capsule with chemotherapy for advanced or late gastric cancer. Henan Journal of Traditional Chinese Medicine 2009;29(2):172.
Wang 2010c {published data only}
  • Wang PP, Lv ZH, Zhang YJ, Sun CX, Xing XR. The effect of Huazhuoheweisanjie Decoction with FOLFOX regimen for advanced or late gastric cancer in 36 patients. Chinese Journal of Integrated Traditional and Western Medicine on Digestion 2010;18(6):403-4.
Wang 2011 {published data only}
  • Wang G, Guan YP. The effect of traditional Chinese medicine with western medicine for late gastric cancer. Contemporary Medicine 2011;17(4):231.
Wen 1997 {published data only}
  • Wen E, Xiong Y. Association with Western and Chinese Traditional Medicines treats 24 patients with advanced gastric cancer. Journal of Jianxi College of Traditional Chinese Medicine 1997;9(3):12-3.
Wu 1992 {published data only}
  • Wu Q. Efficancy of Snake venom preparation in patients of gastric cancer after operation. Chinese Journal of Clinical Oncology 1992;19(1):63.
Wu 2004 {published data only}
  • Wu Y, Guo M. Observation of efficacy about association with Western and Traditional Chinese Medicines treating 92 patients with advanced gastric cancer. Journal of Practical Traditional Chinese Internal Medicine 2004;18(3):207. [: 1671-7813(2004)03-0207-01]
Wu 2009 {published data only}
  • Wu L, Yang Y. A clinical study of treating advanced gastric cancer with the combination of Kangai injection and chemotherapy. Proceeding of Clinical Medicine 2009;18(7):493-6.
Wu 2010 {published data only}
  • Wu JP, Wang LJ, Zhang ZH, Jia HR, Zhao YH. The clinical effect of Shenshexiaoliu with chemotherapy decoction for late gastric cancer in 44 cases. Hebei Journal of Traditional Chinese Medicine 2010;32(11):1674-5.
Xie 2004 {published data only}
  • Xie X, Zheng Z, Li J, Liu D, Liu Y. Effects of xeloda combined with carmofur in the improvement of quality of life in patients with advanced carcinoma of stomach: A randomized controlled observation. Chinese Journal of Clinical Rahabilitation 2004;8(14):2608-9. [: 1671-5926(2004)14-2608-02]
Xiong 2006 {published data only}
  • Xiong M, Yu Q, Tang X. Effect of the traditional Chinese medicine "San Juan Cu Diao Fa" for advanced gastric cancer. Chinese Oncology 2006;15(12):883-4. [: 1004-0242(2006)12-0883-02]
Xu 1999a {published data only}
  • Xu A, Liu J. Huangshen instant herbal medicines combined with chemotherapy treat advanced gastric carcinoma. Guangdong Medical Journal 1999;20(2):150-1.
Xu 2005 {published data only}
  • Xu Z, Liu J, Zhang L. Chinese herbal medicine combined with intraperitoneal chemotherapy for treating intermediate and later gastric carcinoma: a report of 69 cases. Chinese Medical Guide: Medical Journal 2005;3(1):94-6. [: 1671-8194(2005)01-0094-03]
Yan 2010 {published data only}
  • Yan R, Zhang MY, She DJ, Shen GM, Ding Y, Su ZT. The clinical effect of Xiaxing Decoction for advanced or late gastric cancer in 20 patients with Tanyufujie type. Hebei Journal of Traditional Chinese Medicine 2010;32(4):512-3.
Yang 1998 {published data only}
  • Yang Z, Zhu F, Yang S. Apply of Shuganjianwei tablet in treating advanced gastric cancer. Journal of Practical Traditional Chinese Medicine 1998;14(2):13-4.
Yang 2006a {published data only}
  • Yang J. Association with Western and Chinese traditional medicines treats 24 patients with advanced gastric cancer. Anhui Medicine 2006;27(4):335-6.
Ye 2008 {published data only}
  • Ye GC, Yuan WB, Liu LW. Clinical research on treating gastric cancer with Chinese Traditional Medicine. Journal of Zhejiang College of Traditional Chinese Medicine 2008;32(1):73-4.
Yin 1996 {published data only}
  • Yin Z, Zhang Y, Xie Z, Guan C. Elemene plus fluorouracil in the treatment of advanced gastric cancer. Chinese Clinic of Oncology 1996;23(11):810-2.
Yin 1999 {published data only}
  • Yin X, Yu X, Gao Z, Peng C, Tian J, Liu Y, et al. study on therapeutic effect of treating moderate and advanced state gastric cancer by the compound Jiaogulan capsules. Journal of Heze Medical College 1999;11(4):1-3. [: R243 R511 .605]
You 2009 {published data only}
  • You JL, Huang XN. The effect of Fuzhenghewei Decoction with chemotherapy for advanced or late gastric cancer. Shanxi Journal of Traditional Chinese Medicine 2009;30(9):1112-4.
Yu 2006 {published data only}
  • Yu W, Xu Y, Li T, Chen H, Xu X. Clinical observation that Pulse-activating injection plus chemotherapy treat advanced gastric cancer. Zhejiang Journal of Integrated Traditional Chinese and Western Medicine 2006;16(3):159-60.
Zhang 1987 {published data only}
  • Zhang X, Zhang M, Xia D. Clinical observation about Aidean treating advanced stage gastric carcinoma. Journal of Jilin University Medicine Edition 1987;29(5):395.
Zhang 2000 {published data only}
  • Zhang Y. Association with Western and Traditional Chinese Medicines treats 24 patients with metastatic hepatic carcinoma after operation of gastric carcinoma. Liver Ailment of Journal of Traditional Chinese Medicine 2000;10(1):56-7.
Zhang 2009a {published data only}
  • Zhang L, Xiong JP. Kangai injection combined with chemotherapy in advanced gastric cancer. Cancer Research on Prevention and Treatment 2009;36(4):328-30.
Zhang 2010c {published data only}
  • Zhang H'O, Fang WY, Huang MH, Hu GH, Wang WR, Huang HQ, Ye CR. The improvement of living quality from Traditional Chinese Medicine combined with westerm medicine for advanced or late gastric cancer. Fujian Journal of Traditional Chinese Medicine 2010;41(4):8-9.
Zhao 1991 {published data only}
  • Zhao G, Wu Z, Fu H, Ren Z, Li Y. The effects and side-effects of Shenqifuzheng Decoction for late gastric cancer after operation in 83 patients. Liberation Army Medical Journal 1991;16(5):379-81.
Zhao 2009 {published data only}
  • Zhao JG, Xiong JP, Zhang L. Aidi injection combined with chemotherapy in advanced gastric cancer. Journal of Jiangxi University of TCM 2009;21(1):17-9.
Zhao 2011 {published data only}
  • Zhao SP, Li XH. Clinical experience of first-line chemotherapy combined Tianzhicao capsule with the treatment of advanced gastric cancer. Chinese Medicine Modern Distance Education of China 2011;9(5):148-9.
Zheng 1996 {published data only}
  • Zheng W, Zheng J. Chinese herbs and chemotherapy by celiac arterial cannula treat advanced gastric cancer. Intermediate Medical Journal 1996;31(6):54-5.
Zheng 1996a {published data only}
  • Zheng W, Zheng J. TCM and interventional chemotherapy treat 40 patients with advanced cancer. New Digestive Disease Journal 1996;4(12):717.
Zhou 2000a {published data only}
  • Zhou R, Wu L, Ni A, Xu Z. Observations on the curative effect of combined meridian-transmitted millimetre wave and Chinese herbs on intermediate and advanced carcinoma of stomach. Shanghai Journal of Acupuncture and Moxibustion 2000;19(2):7-9. [: 1005-0957(2000)-02-0007-03]
Zhou 2000b {published data only}
  • Zhou J. Clinical report of Huishengtai capsules treating advanced gastric carcinoma. Modern Journal of Integrated Traditional Chinese and Western Medicine 2000;9(6):502-3.
Zhu 1996 {published data only}
  • Zhu H, Li Y, Sun Y. Shenlianwendan combining with MF treat advanced gastric carcinoma of 20 cases. Shandong Chinese Medical Journal 1996;15(12):554.
Zhu 1999 {published data only}
  • Zhu X, Xu J, Huang D, Huang G, Ying X. Clinical and empirical study about Gecko and Radix actinidiae treating gastric carcinoma. China's Naturopathy 1999;3(3):43-4.
Zhu 2004 {published data only}
  • Zhu X, Fang M, Wu Y, Tao H, Yang X. Traditional Chinese Medicine treats patients with gastric carcinoma and partial bowel obstruction. Liaoning Journal of Traditional Chinese Medicine 2004;31(12):1011-2. [: 1000-1719(2004)12-1011-02]
Zhu 2008 {published data only}
  • Zhu LY, Tian L. Effect of TCM decoction therapy on quality of life in 38 post-chemotherapy patients with stomach cancer. Youjiang Medical Journal 2008;36(5):525-7.
Zhu 2009 {published data only}
  • Zhu L, Chen YC. The effect of Fuzhengsanjie decoction with OLF therapeutic regimen for late gastric cancer. Yunnan Journal of Traditional Chinese Medicine and Materia Medica 2009;30(6):7-8.
Zhu 2009a {published data only}
  • Zhu KW. The effect of self-made Wei'aishu with chemotherapy for advanced or late gastric cancer in 46 patients. Chinese Community Doctors 2009;11(10):105-6.

Additional references

  1. Top of page
  2. AbstractRésumé
  3. Summary of findings
  4. Background
  5. Objectives
  6. Methods
  7. Results
  8. Discussion
  9. Authors' conclusions
  10. Acknowledgements
  11. Data and analyses
  12. Appendices
  13. What's new
  14. History
  15. Contributions of authors
  16. Declarations of interest
  17. Sources of support
  18. Notes
  19. Characteristics of studies
  20. References to studies included in this review
  21. References to studies excluded from this review
  22. Additional references
Bu 2001b
  • Bu P, Zhou C, Chen Q. The effects of Recipe of Fuzhenghuayu on inhibiting the metastasis and strengthening immune function of T-cell in patients with gastric cancer after operation. Journal of Traditional Chinese Medicine 2001;42(4):226.
Chen 2001
  • Chen R, Su J, Cai K, Fu Y, Li L. The effect of natural antioxidant of Isoverbascoside on inducing the differentiation of gastric cancer cell. Journal of Xiamen University (Natural Science) 2001;40(4):936-41.
Dai 2009
  • Dai Z, Gao J, Ji Z, Wang X, Ren H, Liu X, et al. Matrine induces apoptosis in gastric carcinoma cells via alteration of Fas/FasL and activation of caspase-3. Journal of Ethnopharmacology  2009;123(1):91-6.
Duan 2002
  • Duan P, He J, Zhang M. The effectiveness of invigorating the spleen and removing toxic substances in the treatment of gastric cancer. Sichuan Traditional Chinese Medicine 2002;20(1):44.
Gu 1995
  • Gu D, Zhang Y. The research advancement of clinical dispensatories in treatment of gastric cancer. Information on Traditional Chinese Medicine 1995;12(1):8-10.
Guo 1997
  • Guo Z, Cheng L. A clinical therapeutic effectiveness analyses of gastric carcinoma. Sichuan Traditional Chinese Medicine 1997;15(3):7-8.
Higgins 2008
  • Higgins J, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions. Chichester: John Wiley & Sons, 2008.
Ji 1989
  • Ji G, Ji J. The advancement of Chinese medicine in treatment of gastric cancer. Jiangsu Journal of Traditional Chinese Medicine 1989;10(2):40-2.
Lin 2003
  • Lin J, Dong H, Oppenheim J, Howard O. Effects of astragali radix on the growth of different cancer cell lines. World Journal of Gastroenterology 2003;9(4):670-3.
Lu 1996
  • Lu W, Sun G, Piao B. The clinical and laboratory research of Yangweikangliu recipe for gastric cancer. Journal of Traditional Chinese Medicine 1996;37(6):350-2.
Lu 2008
Melchart 2002
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Ning 1985
  • Ning C, Wang G, Zhao T, Yu G, Duan F. The effect of Jianpiyishen prescription on toxic-side effects caused by chemotherapy in late gastric cancer after operation. Chinese Journal of Intergrated Traditional and Western Medicine 1985;5(11):668-70.
Parmar 1998
Qiu 1993
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RevMan 2011
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Rui 2008
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Sa 2003
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Shen 2007
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Sun 2002
  • Sun W, Zheng X. A clinical report of Aidi injection with chemotherapy for advanced or late gastric cancer. The Thesis Compilation of National Western and Chinese Traditional Medicine Summit Forum of Oncology. Chinese Medical Association, 2002:126-127.
Tang 2004
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UICC 1997
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Wang 2000
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Wu 2001
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Wu 2008
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Yang 1989
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Zeng 1986
  • Zeng X, Hu P. MFO chemotherapy randomized with addition of Chinese herb medicine in patients with advanced gastric cancer. Chinese Journal of Clinical Oncology 1986;13(3):145-6.
Zhang 2007
Zhao 2002
  • Zhao P, Tang L, Luo J. The effect of Aidi Injection with chemotherapy for gastric cancer after operation. the Thesis Compilation of National Western and Chinese Traditional Medicine Summit Forum of Oncology. Chinese Medical Association, 2002:244-5.
Zheng 2001
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Zhou 1999
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