Journal of Cancer Research and Therapeutics

ORIGINAL ARTICLE
Year
: 2016  |  Volume : 12  |  Issue : 8  |  Page : 244--247

A meta-analysis of elemene versus DDP intrapleural injection in the treatment of malignant pleural effusion caused by lung cancer


Xiaolong Wang1, Haojie Wang1, Li Li2,  
1 Department of Thoracic Surgery, Huaihe Hospital of Henan University, Kaifeng, PR China
2 Nursing College of Henan University, Kaifeng, PR China

Correspondence Address:
Li Li
Nursing College of Henan University, Kaifeng, 475000
PR China

Abstract

Objective: The objective of this study was to evaluate the clinical efficacy of elemene versus DDP intrapleural injection in the treatment of malignant pleural effusion caused by lung cancer by meta-analysis. Materials and Methods: PubMed (1960 ~ 2016.4), EMBASE (1980 ~ 2016.4), and CNKI (1979 ~ 2016.4) databases were searched to identify the clinical studies of elemene intrapleural injection in the treatment of lung cancer malignant pleural effusion. The odds ratio (OR) was used to evaluate the clinical efficacy of elemene in the treatment of pleural effusion compared to cisplatin (DDP). Results: Seven hundred and Thirty-two subjects with 14 studies were finally included in this meta-analysis. Meta-analysis demonstrated that the objective response rate in elemene group was much higher than that in DDP group (OR = 1.34, 95% confidence interval: 1.07 ~ 1.69, P < 0.05). The Begg's funnel plot and Egger's line regression test showed no statistical publication bias. Conclusion: High clinical efficacy of elemene in the treatment of lung cancer malignant pleural effusion was found compared to DDP.



How to cite this article:
Wang X, Wang H, Li L. A meta-analysis of elemene versus DDP intrapleural injection in the treatment of malignant pleural effusion caused by lung cancer.J Can Res Ther 2016;12:244-247


How to cite this URL:
Wang X, Wang H, Li L. A meta-analysis of elemene versus DDP intrapleural injection in the treatment of malignant pleural effusion caused by lung cancer. J Can Res Ther [serial online] 2016 [cited 2022 Jul 6 ];12:244-247
Available from: https://www.cancerjournal.net/text.asp?2016/12/8/244/200748


Full Text

 Introduction



Lung cancer is the most diagnosed malignant carcinoma clinically. The epidemiology study showed that about 1 million people were dead of lung cancer in the year of 2012, and lung cancer has become the first cause of cancer-related death.[1] Pleural effusion caused by pleural cavity metastasis was often observed in advanced stage lung cancer patients. Huge pleural effusion can cause respiratory and circulatory failure which need urgent treatment.[2] In most of the cases, the treatment procedure was closed drainage of thoracic cavity and chemotherapy drugs pleural cavity injection which can reduce the pressure on the lung tissue and the heart.[3] The most used drug, intrapleural injection, was DDP which can kill the metastatic lung cancer cell and reduce the pleural effusion.[4] However, the pleural adhesion effects were poor. Several studies have reported the efficacy of elemene intrapleural injection for the treatment of malignant pleural effusion caused by lung cancer. However, the conclusion was not in accordance with each other. Therefore, to further evaluate the clinical efficacy of elemene intrapleural injection in the treatment of malignant pleural effusion caused by lung cancer, we performed this meta-analysis by pooling the open published data.

 Materials and Methods



Publication searching strategy

PubMed (1960 ~ 2016.4), EMBASE (1980 ~ 2016.4), and CNKI (1979 ~ 2016.4) databases were searched to identify the clinical studies of elemene intrapleural injection in the treatment of lung cancer malignant pleural effusion. The searching items were elemene, lung cancer/nonsmall cell lung cancer, pleural effusion, and elemene. The searching languages were restriction to English and Chinese.

Inclusion and exclusion criteria

Inclusion criteria

(1) The study design was clinical controlled trials with or without blindness; (2) the patients included in the study were diagnosed of lung cancer with pleural effusion; (3) the patients were treated with DDP or elemene; (4) the original study can provide enough data to calculate the odds ratio (OR); (5) paper published in English or Chinese.

Exclusion criteria

(1) Retrospective study or case report or review; (2) the original study cannot provide enough data to calculate the OR; (3) repeat published literature; (4) pleural effusion caused by other disease such as infection.

Data extraction

The data of original included studies were extracted by two reviewers independently. The extracted information or data included the title of the papers, the first author, the journal of publication, the year of publication, the treatment period, the treatment drugs and dosage, and the number of patients with response. The extracted data or information were cross-checked by the two reviewers.

Statistical analysis

The data were analyzed by the statistical software Stata 12.0 (Stata Corporation, College Station, TX, USA) using a fixed or random effects model according to the heterogeneity analysis. The results of discontinuous data were reported as OR with 95% confidence interval (CI), P < 0.05 was considered to indicate a statistically significant difference. The publication bias was evaluated by Begg's funnel plot and Egger's line regression test.

 Results



General characteristics of included publications

Through searching the PubMed and Wanfang databases, we initially find 126 publications. After reading the title and abstract, 96 studies were excluded for not some reasons. Moreover, 16 papers were excluded after reading the whole paper. Finally, 14 studies [5],[6],[7],[8],[9],[10],[11],[12],[13],[14],[15] were included in the present study with 371 cases in the elemene group and 361 subjects in the DDP group. The general characteristics of the 14 studies are demonstrated in [Table 1].{Table 1}

Meta-analysis

Because of no significant statistical heterogeneity was found (I2 = 0.00%, P = 0.99), the effect size of OR was pooled by fixed effect model. Meta-analysis demonstrated that the objective response rate in elemene group was much higher than that in other drugs group (OR = 1.34, 95% CI: 1.07 ~ 1.69, P < 0.05) [Figure 1].{Figure 1}

Sensitivity analysis

The sensitivity analysis was taken by excluding each of the included studies. The pooled OR ranged from 1.17 to 1.21 which was still more than 1. The sensitivity indicated that the pooled results were not sensitivity to each of the included 14 publications [Figure 2].{Figure 2}

Publications

We use Begg's funnel plot and Egger's line regression test to evaluate the publications. The Begg's funnel plot was left and right symmetric without publication. The Egger's line regression test showed the t = –0.74, P = 0.47 which indicated no significant publication bias [Figure 3].{Figure 3}

 Discussion



Huge pleural effusion can cause respiratory and circulatory failure which needs urgent treatment. The prognosis was poor for patients with huge malignant pleural effusion, and the median survival was less than 12 months.[16] The traditional Chinese medicine believe that the malignant pleural effusion belonged to Xuanyin category, and it was the results of body toxin and other factors, such as disorder of lung, spleen and kidney dysfunction, Sanjiao channel obstruction, obstruction of lung qi descending and documented and et al. The main reason of malignant pleural effusion was metastasis of disease of pleura. In general, the pleural effusion should be firstly drainage and then injected by chemotherapy drugs into the pleural cavity which can reduce the pressure on the lung tissue and the heart and made the visceral and parietal pleural adhering together.[10] The most used drug, intrapleural injection, was DDP which can kill the metastatic lung cancer cell and reduce the pleural effusion.[17] Another drug elemene was also widely used for the treatment of malignant pleural effusion. Several studies [4],[13] have reported the clinical efficacy of elemene intrapleural injection in the treatment of malignant pleural effusion caused by lung cancer. However, the results were not in accordance with each other. Therefore, to further evaluate the clinical efficacy of elemene intrapleural injection in the treatment of malignant pleural effusion caused by lung cancer, we performed this meta-analysis by pooling the open published data.

In the present meta-analysis, we included 14 papers with 732 subjects. The pooled results showed that objective response rate in elemene group was much higher than that in DDP group (OR = 1.34, 95% CI: 1.07 ~ 1.69, P < 0.05). The pooled results indicated that patients who received elemene intrapleural injection have more chance to gain complete or partial response compared to DDP. The sensitivity indicated that the pooled results were not sensitivity to each of the included 14 publications, which means the results were stable and cannot be affected by a single study. Moreover, the publication bias evaluation showed no significant publication bias in this meta-analysis. Hence, we believe that the clinical efficacy of elemene was superior to DDP in the treatment of malignant pleural effusion caused by lung cancer.

Financial support and sponsorship

Foundation: Key project of science and technology research, department of education, henan province In 2015 (No.15A320044).

Conflicts of interest

There are no conflicts of interest.

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