Chinese herbal medicine for colorectal cancer: An overview of systematic reviews and evidence map

Table 1 Summary of findings of evidence in administration of Chinese herbal medicine for postoperative recovery

Ref.	Patients details	Numbers of RCTs	Participants		Effect estimates	Quality of evidence
			Treatment	Control
Time to first bowel sound recovery
Zhang and Cao[27]	Postoperative CRC	18	838	831	MD = -10.16, 95%CI: -12.90 to -7.42	Low1,2
Hu et al[30]	Postoperative RC	6	266	262	MD = -16.59, 95%CI: -19.05 to -14.14	Low1,2
Time to first anal flatus
Zhang and Cao[27]	Postoperative CRC	40	1751	1735	MD = -12.17, 95%CI: -14.11 to -10.24	Low1,2
Hu et al[30]	Postoperative RC	6	266	262	MD = -12.30, 95%CI: -13.07 to -11.52	Low1,2
Time to first defecation
Zhang and Cao[27]	Postoperative CRC	33	1411	1400	MD = -15.41, 95%CI: -18.06 to -12.76	Low1,2
Hu et al[30]	Postoperative RC	5	231	227	MD = -14.17, 95%CI: -17.17 to -11.18	Low1,2

¹Risk of bias of included trials.

²Clinical heterogeneity.

CHM: Chinese herbal medicine; RCT: Randomized controlled trial; CRC: Colorectal cancer; RC: Rectal cancer; MD: Mean difference; CI: Confidence interval.

Table 2 Summary of findings of evidence in adjuvant chemotherapy combined with Chinese herbal medicine

Ref.	Patients details	Numbers of RCTs	Participants		Effect estimates	Quality of evidence
			Treatment	Control
1-year RFS rate
Tang et al[31]	Postoperative CRC	11	509	486	RR = 0.39, 95%CI: 0.27-0.57	Low1,2
2-year RFS rate
Tang et al[31]	Postoperative CRC	8	411	399	RR = 0.40, 95%CI: 0.29-0.54	Low1,2
3-year RFS rate
Tang et al[31]	Postoperative CRC	9	645	643	RR = 0.52, 95%CI: 0.43-0.61	Low1,2
Performance status (KPS improvement rate)
Zhao et al[34]	Postoperative CRC	12	368	367	RR = 0.36, 95%CI: 0.26-0.51	Low1,2

¹Risk of bias of included trials.

²Clinical heterogeneity.

CHM: Chinese herbal medicine; RCT: Randomized controlled trial; RFS: Relapse-free survival; KPS: Karnofsky Performance Status; CRC: Colorectal cancer; RR: Risk ratio; CI: Confidence interval.

Table 3 Summary of findings of evidence in administration of Chinese herbal medicine for advanced colorectal cancer

Ref.	Details of PICO	Numbers of RCTs	Participants		Effect estimates	Quality of evidence
			Treatment	Control
OS
Sun et al[66]	Oral administration of CHM + chemotherapy vs chemotherapy for advanced CRC	4	201	196	HR = 0.66, 95%CI: 0.52-0.83	Low1,2
1-year survival
Xu et al[40]	Oral administration of CHM for advanced CRC of stage IV or Duke’s D	4	112	97	RR = 1.27, 95%CI: 1.07-1.52	Low1,3
2-year survival
Xu et al[40]	Oral administration of CHM for advanced CRC of stage IV or Duke’s D	2	62	47	RR = 1.19, 95%CI: 0.85-1.68	Low1,3
ORR
Zhang[42]	Oral administration of CHM + chemotherapy vs chemotherapy for advanced CRC	54	2209	2188	OR = 1.41, 95%CI: 1.32-1.49	Low1,2
Wu[62]	Oral administration of CHM + chemotherapy vs chemotherapy for advanced CC	29	1229	1176	OR = 1.77, 95%CI: 1.49-2.11	Low1,2
Zhao et al[61]	Oral administration of CHM + FOLFOX vs FOLFOX for advanced CRC	6	198	192	RR = 1.34, 95%CI: 1.11-1.63	Low1,3
Zhao et al[61]	Oral administration of CHM + XELOX vs XELOX for advanced CRC	12	400	395	RR = 1.44, 95%CI: 1.21-1.70	Moderate1
Zhou et al[43]	CKI + oxaliplatin-based chemotherapy vs oxaliplatin-based chemotherapy for advanced CRC	31	1247	1234	RR = 1.40, 95%CI: 1.29-1.51	Low1,2
Wu[56]	CKI + FOLFOX vs FOLFOX for advanced CRC	8	280	281	RR = 1.26, 95%CI: 1.12-1.43	Moderate 1
Li[44]	ADI + FOLFIRI vs FOLFIRI for advanced CRC	7	298	295	RR = 1.16, 95%CI: 0.96-1.41	Low1,4
Hu et al[28]	ADI + FOLFOX4 vs FOLFOX4 for advanced CRC	16	705	672	RR = 1.22, 95%CI: 1.11-1.34	Moderate 1
Peng et al[45]	BJOEI + FOLFIRI vs FOLFIRI for advanced CRC	6	269	259	RR = 1.30, 95%CI: 1.17-1.45	Low1,5
Peng et al[45]	BJOEI + FOLFOX vs FOLFOX for advanced CRC	6	257	244	RR = 1.45, 95%CI: 1.22-1.72	Low1,5
Wang et al[48]	SFI + first-line chemotherapy vs first-line chemotherapy for advanced CRC	12	445	428	RR = 1.35, 95%CI: 1.18-1.55	Low1,2
Liao et al[86]	KLTI + chemotherapy vs chemotherapy for advanced CRC	6	265	259	OR = 1.96, 95%CI: 1.36-2.81	Low1,2
Zhang et al[82]	KAI + FOLFIRI vs FOLFIRI for advanced CRC	4	150	149	OR = 1.82, 95%CI: 1.16-2.87	Low1,3
Huang et al[47]	KAI + chemotherapy vs chemotherapy for advanced CRC	22	878	837	RR = 1.32, 95%CI: 1.22-1.43	Low1,2
DCR
Xu et al[40]	Oral administration of CHM for advanced CRC (stage IV or Duke’s D)	37	955	903	RR = 1.12, 95%CI: 1.06-1.17	Low1,2
Zhou et al[43]	CKI + oxaliplatin-based chemotherapy vs oxaliplatin-based chemotherapy for advanced CRC	31	1247	1234	RR = 1.12, 95%CI: 1.08-1.16	Low1,2
Wu et al[51]	CKI + FOLFOX vs FOLFOX for advanced CRC	8	280	281	RR = 1.06, 95%CI: 1.01-1.12	Low1,5
Li[44]	ADI + FOLFIRI vs FOLFIRI for advanced CRC	5	226	226	RR = 1.14, 95%CI: 1.02-1.28	Low1,4
Hu et al[28]	ADI + FOLFOX4 vs FOLFOX4 for advanced CRC	16	701	666	RR = 1.10, 95%CI: 1.05-1.16	Moderate1
Wang et al[48]	SFI + first-line chemotherapy vs first-line chemotherapy for advanced CRC	11	410	396	RR = 1.12, 95%CI: 1.05-1.19	Low1,2
Difference of KPS score between pre-treatment and post-treatment
Xu et al[40]	Oral administration of CHM for advanced CRC (stage IV or Duke’s D)	24	583	572	MD = 6.23, 95%CI 4.75-7.70	Low1,2
KPS improvement rate
Li[52]	Oral administration of CHM + chemotherapy for metastatic CRC	16	586	548	RR = 1.46, 95%CI: 1.35-1.58	Low1,2
Zhou et al[43]	CKI + FOLFOX4 vs FOLFOX4 for advanced CRC	16	658	636	RR = 1.24, 95%CI: 1.14-1.36	Moderate1
Hu et al[28]	ADI + FOLFOX4 vs FOLFOX4 for advanced CRC	7	329	304	RR = 1.30, 95%CI: 1.18-1.44	Moderate1
Peng et al[45]	BJOEI + FOLFOX vs FOLFOX for advanced CRC	3	139	126	RR = 1.31, 95%CI: 1.13-1.53	Low1,3
Wang et al[48]	SFI + first-line chemotherapy vs first-line chemotherapy for advanced CRC	7	257	240	RR = 1.26, 95%CI: 1.13-1.40	Low1,2
Huang et al[47]	KAI + chemotherapy vs Chemotherapy for advanced CRC	17	647	575	RR = 1.48, 95%CI: 1.36-1.60	Low1,2

¹Risk of bias of included trials.

²Clinical heterogeneity.

³Limited sample size.

⁴Confidence intervals of overlap risk ratio of 1.0 or mean difference of 0.

⁵Publication bias detected.

CHM: Chinese herbal medicine; PICO: Population Intervention Comparison Outcome; RCT: Randomized controlled trial; OS: Overall survival; ORR: Objective response rate; DCR: Disease control rate; CRC: Colorectal cancer; CKI: Compound Kushen Injections; ADI: Aidi Injections; BJOEI: Brucea Javanica Oil Emulsion Injections; KAI: Kangai Injections; SFI: Shenqi Fuzheng Injections; KLTI: Kanglaite Injections; XAPI: Xiaoaiping Injection; MD: Mean difference; OR: Odds ratio; RR: Risk ratio; HR: Hazard ratio; CI: Confidence interval.

Table 4 Summary of findings of evidence in administration of Chinese herbal medicine for colorectal cancer of unrestricted stage or status

Ref.	Details of PICO	Numbers of RCTs	Participants		Effect estimates	Quality of evidence
			Treatment	Control
KPS improvement rate
Wu[62]	Oral administration of CHM + chemotherapy for CC	15	529	492	OR = 3.81, 95%CI: 2.69-5.38	Low1,2
Zhao et al[61]	Oral administration of CHM + FOLFOX vs FOLFOX for CRC	8	248	233	RR = 2.20, 95%CI: 1.64-2.95	Low1,2
Wu et al[71]	SFI + chemotherapy vs chemotherapy for CRC	13	585	555	RR = 1.72, 95%CI: 1.49-1.99	Low1,2
Zhang et al[79]	SFI + FOLFOX vs FOLFOX for CRC	7	306	296	RR = 1.76, 95%CI: 1.40-2.23	Low1,2

¹Risk of bias of included trials.

²Clinical heterogeneity.

CHM: Chinese herbal medicine; PICO: Population Intervention Comparison Outcome; RCT: Randomized controlled trial; KPS: Karnofsky Performance Status; CRC: Colorectal cancer; CC: Colon cancer; SFI: Shenqi Fuzheng Injections; OR: Odds ratio; RR: Risk ratio; CI: Confidence interval.