Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents  
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


1 Department of Thoracic Surgery, Huaihe Hospital of Henan University, Kaifeng, PR China
2 Nursing College of Henan University, Kaifeng, PR China

Date of Web Publication22-Feb-2017

Correspondence Address:
Li Li
Nursing College of Henan University, Kaifeng, 475000
PR China
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1482.200748

Rights and Permissions
 > 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.

Keywords: Elemene, lung cancer, meta-analysis, pleural effusion


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;12:244-7

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 2017 Jul 28];12:244-7. Available from: http://www.cancerjournal.net/text.asp?2016/12/8/244/200748


 > Introduction Top


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 Top


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 Top


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: The general characteristics of included publications

Click here to view


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: The forest plot of clinical effect for elemene intrapleural injection

Click here to view


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: The forest for sensitivity analysis

Click here to view


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: The funnel plot of evaluation of the publication bias

Click here to view



 > Discussion Top


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.

 
 > References Top

1.
Aihe Y, Xiaoyang X. Clinical analysis of elemene in the treatment of pleural effusion. Hebei Med 2001;26:805-6.  Back to cited text no. 1
    
2.
Boquan Y, Fagnji W, Chunli J. Comparison of elemene and cisplatin for malignant pleural effusion. J Pract Oncol 2000;32:212-3.  Back to cited text no. 2
    
3.
Doelken P. Management of pleural effusion in the cancer patient. Semin Respir Crit Care Med 2010;31:734-42.  Back to cited text no. 3
    
4.
Fengyue W. Clincial efficacy analysis of elemene and cisplatin in treatment of malignant pleural effusion. Hebei Med J 1998;23:169-70.  Back to cited text no. 4
    
5.
Wanling Z, Huaqing W, Liqing L. Anticancer drug Eiemene intrapleural infusion in treatment of malignant pleural effusion phase II clinical summary. Chin J Clin Oncol 1996;11:75.  Back to cited text no. 5
    
6.
Shuntong L, Qingnan Q. A clinical observation of elemene in treatment of advanced lung cancer with pleural effusion. Fujian Med J 1996;8:90.  Back to cited text no. 6
    
7.
Hongxin Z, Xia Z, Shengguo C. Elemene treatment of elderly patients with advanced cancer were observed: report of 36 cases. Shenzhen J Integr Tradit Chin West Med 1997;20:29-30.  Back to cited text no. 7
    
8.
Ping W, Yu W. Elemene intrapleural injection in treatment of advanced lung cancer with pleural effusion clinical observation. Mod J Integr Tradit Chin West Med 2005;33:180-1.  Back to cited text no. 8
    
9.
Lixin G, Feng F. Observation of elemene injection intrapleural injection in the treatment of malignant pleural effusion. Mod J Integr Tradit Chin West Med 2002;30:708-9.  Back to cited text no. 9
    
10.
Xianli B. Intrapleural injection of elemene and cisplatin in the treatment of malignant pleural effusion. Mod J Integr Tradit Chin West Med 2005;21:321-2.  Back to cited text no. 10
    
11.
Guoqiang S. The curative effect of intrapleural injection of elemene in the treatment of malignant pleural effusion. J Chin Pract Diagn Ther 2007;28:373-4.  Back to cited text no. 11
    
12.
Ming L. Clinical observation of elemene in the treatment of malignant pleural effusion. J Henan Univ Chin Med 2008;33:58.  Back to cited text no. 12
    
13.
Junzhong S, Xuguang J, Ke Z, Xiaojing Z, Haichen L. Clinical efficacy of elemene pleural cavity injection in the treatment of malignant pleural effusion. Chin J Clin Res 2009;22:532-3.  Back to cited text no. 13
    
14.
Haisong W, Ping C. Clinical study of intrapleural injection of elemene in the treatment of malignant pleural effusion. Guide China Med 2001;26:165-6.  Back to cited text no. 14
    
15.
Lanying S. Clinical observation of elemene intrapleural injection in the treatment of lung cancer with malignant pleural effusion. Chin Community Doct 2012;41:80  Back to cited text no. 15
    
16.
Wcislo G, Miedzinska M. Pleural effusion in cancer patients: Pathophysiology, diagnosis and treatment. Pol Merkur Lekarski 1999;6:33-6.  Back to cited text no. 16
    
17.
Zarogoulidis P, Chatzaki E, Hohenforst-Schmidt W, Goldberg EP, Galaktidou G, Kontakiotis T, et al. Management of malignant pleural effusion by suicide gene therapy in advanced stage lung cancer: A case series and literature review. Cancer Gene Ther 2012;19:593-600.  Back to cited text no. 17
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

  >Abstract>Introduction>Materials and Me...>Results>Discussion>Article Figures>Article Tables
  In this article
>References

 Article Access Statistics
    Viewed590    
    Printed7    
    Emailed0    
    PDF Downloaded71    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]