LI Chen-chen, ZHANG Ya-ling, ZHENG Yu-ling

Henan University of Chinese Medicine, Zhengzhou 450000, China

Keywords:Primary liver cancer PostTACE syndrome Chinese medicine Systematic review

ABSTRACT

1. Introduction

The morbidity and mortality of primary liver cancer are the 6th and 3rd in the world, respectively, and the 5th and 2nd in China [1, 2]. In addition to early-stage primary liver cancer that can be radically cured by surgery, hepatic arterial chemoembolization (TACE)is often used in the treatment of middle and advanced stages [3].For patients with advanced primary liver cancer, compared with systemic systemic chemotherapy, TACE can improve the survival rate, and the side effects are less, but about 90% of patients after TACE develop embolism syndrome, which is manifested as fever and pain in the liver area, abdominal distension, abdominal pain,etc. [4], in addition, there is a decrease in the quality of life and many symptoms of traditional Chinese medicine.

At present, a preliminary consensus has been reached on the opinion that the rehabilitation treatment of combined traditional Chinese and Western medicine is more advantageous for the postoperative TACE syndrome of primary liver cancer [5]. Existing Meta-analysis [6] shows that adjuvant traditional Chinese medicine therapy based on conventional western medicine treatment after TACE can improve the 1-year survival rate and clinical efficacy of patients, but the trials conducted in recent years have not been updated in time; the quality of evidence has not been evaluated;The improvement of postoperative symptoms and postoperative quality of life were not focused on. On this basis, this study will systematically evaluate the clinical trials of loading oral traditional Chinese medicines in the treatment of primary liver cancer after TACE syndrome, focusing on the improvement of postoperative symptoms and quality of life of patients, in order to provide clinical evidence for postoperative TACE syndrome.

2. Materials and methods

2.1 Search strategy

China National Knowledge Infrastructure, VIP Full-text Database,Wanfang Database, China Biomedical Literature Database, PubMed,MEDLINE, Web of Science were searched by computer, and the references of the included literature were manually searched. The retrieval time is from the establishment of each database to March 31, 2022. Cross-searched by subject headings and free words, the Chinese search terms are: traditional Chinese medicine, traditional Chinese medicine, primary liver cancer, TACE; the English search terms are Chinese medicine, traditional Chinese medicine,hepatocellular carcinomas, TACE.

2.2 Literature Inclusion Criteria

(1) Type of study: A randomized controlled trial (RCT) to study the efficacy of oral Chinese herbal medicine on patients with primary liver cancer after TACE syndrome, regardless of whether it is blinded or not, and the language is not limited. (2) Subjects: Patients with primary liver cancer who developed postoperative TACE syndrome after TACE treatment. (3) Intervention measures: The experimental group received Western medicine symptomatic treatment plus oral Chinese medicine; the control group received Western medicine symptomatic treatment alone after surgery. (4) Outcome indicators:include at least one of the following outcome indicators: incidence of syndrome and duration of symptoms after TACE (including fever,nausea and vomiting, liver pain, abdominal distension and abdominal pain, loose stools, constipation), KPS score, clinical TCM syndrome Symptom score, short-term efficacy of tumor, one-year survival rate,liver function indicators (alanine aminotransferase ALT, aspartate aminotransferase AST, serum albumin ALB, total bilirubin TBil),immune function indicators (CD3+, CD4+, CD8+, CD4+, CD8+).

2.3 Literature exclusion criteria

(1) The included patients included those with non-primary liver cancer. (2) Research on the use of traditional Chinese medicines during the peri-TACE period. (3) The data description is incomplete,or the study results cannot be used to calculate the outcome measure.(4) Duplicate published literature.

2.4 Literature screening and data extraction

Two researchers independently searched and screened the literature according to the inclusion and ranking criteria. The screening steps were as follows: import the retrieved literature into Endnote X9 software to remove duplicates, then read the title and abstract for preliminary screening, and finally read the full text to determine the final inclusion of the literature. Data extraction was then performed independently by two investigators. In the event of missing data, the trial investigators were contacted by email or telephone. If the above process is controversial, it will be discussed and evaluated by a third researcher.

2.5 Quality Evaluation

According to the risk of bias assessment tool (risk of bias) provided by the Cochrane Collaboration, the included literature was assessed for risk of bias and methodological quality. The specific assessment contents included: randomization method, allocation concealment implementation, blinding implementation, data integrity situation,whether there is publication bias, whether there is other bias such as baseline data comparability [7].

2.6 Statistical methods

Meta-analysis was performed on the extracted data using RevMan 5.4 software. The relative risk (RR) was used as the statistic for the enumeration data, and the standardized mean difference (SMD) was used as the statistic for the continuous variable data, and the 95%CI was calculated. The I2test was used to evaluate the heterogeneity among studies. If I2≤50%, a fixed-effect model was used; if I2>50%,a subgroup analysis was performed to explore clinical heterogeneity or The source of methodological heterogeneity, when the source of heterogeneity is not clear, the random effect model is used to combine the effect size [8]. If more than 10 studies were included, a funnel plot was used to assess publication bias.

2.7 Evidence quality assessment

According to the GRADE evaluation criteria, the GRADEprofiler 3.6 software was used to evaluate the quality of evidence, which may be affected by study limitations, inconsistent results, direct evidence uncertainty, imprecision of results, and publication bias [9].

3. Results

3.1 Literature search and screening results

According to the search strategy, 402 Chinese and English literatures were initially retrieved, including 396 Chinese and 6 English literatures. 90 duplicate literatures were eliminated by software deduplication and manual deduplication, and then those that did not meet the inclusion criteria were eliminated by reading the title, abstract and full text. A total of 268 articles were included,and 44 studies were finally included, all of which were in Chinese.

3.2 Basic features of the included literature

44 studies was included [10-53]. All were RCTs, and a total of 3 992 patients with primary liver cancer were included, including 1 989 in the experimental group and 2 003 in the control group plus placebo.The intervention measures in the control group were all conventional western medicine symptomatic treatment after TACE, and the experimental group was additionally given oral Chinese medicine on the basis of the control group. Among them, 39 studies were Chineseherbal decoctions, and 5 studies were Chinese patent medicines (2 granules, 2 capsules, 1 oral liquid). See Table 1 for details.

Table 1 Basic characteristics of included literature

Note: - : Unavailable; ① : Incidence or duration of fever; ②: Incidence or duration of nausea and vomiting; ③: Incidence or duration of pain in liver area; ④: Incidence or duration of abdominal distension and abdominal pain; ⑤: Constipation Duration; ⑥: duration of loose stool; ⑦: KPS score; ⑧: clinical TCM syndrome score; ⑨: short-term curative effect of tumor body; ⑩: 1-year survival rate; ?: other.

3.3 Quality evaluation of the included literature

In terms of random sequence generation methods, there are 18 studies [12, 17, 24, 25, 26, 29, 30, 33, 34, 38, 39, 41, 42, 45, 45, 47, 52, 53] is the random number table method, three studies [40, 43, 49] implemented randomization according to the order of admission, and the rest of the literature only mentioned the word random. Two studies [23, 44]mentioned blinding, of which one [23] was double-blind and one [44]was single-blind. 3 studies [22, 36, 吖49] data were missing. Allocation concealment was not mentioned in all studies, and outcome measures were reported in all studies. See Figure 1 for details.

3. 4 Meta analysis results

3.4.1 Incidence and duration of postoperative fever

Figure 1 Risk of bias graph

A total of 6 [12, 19, 22, 24, 25, 37] endings were included The index is the study of the incidence of fever. The results show that the heterogeneity of the results of each study is relatively large (P=0.03,I2=61%), and the grouping criteria are based on the characteristics of patients' gender and age, treatment cycle, sample size, and research method. Subgroup analysis was carried out in turn, and it was found that the heterogeneity between groups was significantly reduced when the treatment period was used as the standard for subgroup analysis. Therefore, it was inferred that the difference in treatment period may be the source of heterogeneity, so the subgroup analysis was carried out with the 7-day course of treatment as the boundary, and a random-effects model was used. The results showed that compared with conventional western medicine symptomatic treatment, loading oral Chinese medicine could further reduce the incidence of fever after TACE [RR=1.45, 95%CI (1.09, 1.92),P=0.01]. See Figure 2 for details.

Include 15 items [10, 15, 17, 18, 20, 23, 28, 34, 35, 36, 41, 44, 45, 47, 52]The outcome of the study was the duration of fever, and the results showed that the heterogeneity among the studies was large (P<0.001,I2=96% ), and the subgroup analysis was conducted according to the differences in the gender and age characteristics of the patients,the size of the sample size, and the research methods. No source of heterogeneity was found, so a random-effects model was used.Meta-analysis results showed that compared with conventional western medicine symptomatic treatment, loading oral Chinese medicine could significantly shorten the duration of fever after TACE [SMD=2.11, 95%CI (1.43, 2.79), P<0.001]. See Figure 3 for details.

Figure 2 Forest map of fever incidence

3.4.2 Incidence and duration of postoperative nausea and vomiting

A total of 6 [12, 22, 24, 25, 33, 37] endings were included .The index is the research on the incidence of nausea and vomiting. The results show that the heterogeneity of the results of each study is relatively large (P=0.002, I2=73%). According to the patient's gender, age characteristics, treatment cycle, sample size and research method Subgroup analysis was performed in turn by grouping criteria, and no clear source of heterogeneity was found, and a random-effects model was used. Meta-analysis results showed that compared with conventional western medicine symptomatic treatment, loading oral Chinese medicine could further reduce the incidence of nausea and vomiting after TACE [RR=1.47, 95%CI (1.10, 1.95), P=0.009]. See Figure 4 for details.

Figure 3 Forest map for duration of fever

Figure 4 Forest map of incidence of nausea and vomiting

Include 15 items [10, 15, 17, 18, 20, 23, 28, 34, 35, 36, 41, 44, 45, 47,52] The outcome of the study was the duration of fever, and the results showed that the heterogeneity among the studies was large(P<0.001, I2=91% ), subgroup analysis was performed, no source of heterogeneity was found, and a random-effects model was used.Meta-analysis results showed that compared with conventional western medicine symptomatic treatment, loading oral Chinese medicine could significantly shorten the duration of nausea and vomiting after TACE [SMD=1.67, 95%CI (1.22, 2.11), P<0.001]. See Figure 5 for details.

3.4.3 Incidence and duration of postoperative liver pain

Three studies [19] ,[24] ,[33] whose outcome was the incidence of nausea and vomiting were included, and the results showed good homogeneity among the studies (P=0.35, I2=4%), using a fixedeffects model. Meta-analysis results showed that compared with conventional western medicine symptomatic treatment, loading oral Chinese medicine could further reduce the incidence of liver pain after TACE [RR=1.21, 95%CI (1.02, 1.43), P=0.03]. See Figure 6 for details.

Figure 5 Forest map for duration of nausea and vomiting

Include 9 items [17, 19, 23, 28, 34, 36, 41, 44, 45] .The outcome index was the study of the duration of pain in the liver region, and the results showed that the heterogeneity among the studies was large(P<0.001, I2=91%), subgroup analysis was performed, no source of heterogeneity was found, and a random effects model was used.Meta-analysis results showed that compared with conventional western medicine symptomatic treatment, loading oral Chinese medicine could significantly shorten the duration of liver pain after TACE [SMD=1.90, 95%CI (1.30, 2.51), P<0.001]. See Figure 7 for details.

3.4.4 Incidence and duration of postoperative abdominal distension and abdominal pain

Three studies were included [12, 22, 25] , whose outcome index was the incidence of abdominal distension and abdominal pain, and the results showed good homogeneity among the studies (P=0.30,I2=18%), using a fixed-effects model. Meta-analysis results showed that compared with conventional western medicine symptomatic treatment, loading oral Chinese medicine had no significant advantage in reducing the incidence of abdominal distension and abdominal pain after TACE [RR=1.18, 95%CI (1.00, 1.39), P=0.05].See Figure 8 for details.

Include 8 items [10, 15, 18, 20, 34, 41, 47, 52] .The outcome indicator was the duration of abdominal distension and abdominal pain, and the results showed that the heterogeneity among the studies was large.Age characteristics, sample size, and differences in research methods were used as the grouping criteria for subgroup analysis. The results of subgroup analysis showed that the difference in sample size was most likely the source of heterogeneity. Therefore, the sample size of 30 cases and 60 cases was used as the grouping boundary. Subgroup analyses were performed using a random effects model. The results showed that compared with conventional western medicine symptomatic treatment, loading oral Chinese medicine could shorten the duration of abdominal distention and abdominal pain after TACE[SMD=1.27, 95%CI (0.75, 1.79), P<0.001]. Heterogeneity arises from small sample subgroups. See Figure 9 for details.

3.4.5 Duration of postoperative constipation/loose stools

Five studies [10, 17, 34, 36, 44] whose outcome was duration of constipation were included. The heterogeneity between studies was large (P<0.001, I2=94%), and the subgroup analysis was carried out according to the gender and age characteristics of patients,the size of the sample, and the different research methods as the grouping criteria. The results of the subgroup analysis showed that the sample size. The difference may be the source of heterogeneity,so a subgroup analysis was performed with a sample size of 30 cases as the grouping boundary, and a random effect model was used. The results showed that compared with conventional western medicine symptomatic treatment, loading oral Chinese medicine could significantly shorten the duration of constipation symptoms after TACE [SMD=2.30, 95%CI (1.24, 3.36), P<0.001], and the heterogeneity was due to Small sample subgroups. See Figure 10 for details.

Figure 6 Forest map of incidence of liver pain

Figure 7 Forest map for duration of liver pain

Figure 8 Forest map of incidence of abdominal distension and pain

Figure 9 Forest map for duration of abdominal distension and pain

Figure 10 Forest map for duration of constipation

Four studies [18, 20, 28, 45] whose outcome was duration of constipation were included, with large heterogeneity among the studies (P=0.003, I2=78%), and the subgroup analysis was carried out according to the above grouping criteria. The results showed that the difference in sample size was most likely the source of heterogeneity. Therefore, the subgroup analysis was carried out with a sample size of 30 cases as the grouping boundary, and randomization was used for the subgroup analysis. effect model.The results showed that compared with conventional western medicine symptomatic treatment, loading oral Chinese medicine could significantly shorten the duration of loose stool symptoms after TACE [SMD=2.18, 95%CI (1.52, 2.84), P<0.001], and the heterogeneity still remained, derived from small sample subgroups.See Figure 11 for details.

3.4.6 KPS score improvement rate

14 [10, 12, 13, 15, 21, 23, 25, 26, 35, 38, 47, 48, 50, 51] The outcome indicator was the KPS score improvement rate of the studies. The results showed moderate heterogeneity among studies (P=0.003, I2=58%),and a random-effects model was used. Meta-analysis results showed that compared with conventional western medicine symptomatic treatment, loading oral Chinese medicine had obvious advantages in improving the quality of life after TACE for primary liver cancer[RR=0.73, 95%CI (0.65, 0.82), P<0.001]. See Figure 12 for details.

Figure 11 Forest map for duration of loose stool

Figure 12 Forest map for KPS score improvement rate

In addition, 17 studies [14, 18, 19, 20, 21, 27, 29, 31, 32, 34, 36, 39, 40, 44, 45,52, 53] Outcome indicator is KPS score, heterogeneity among studies Larger (P<0.001, I2=88%), random effects model was used. The results showed that loading oral traditional Chinese medicine had obvious advantages in improving the quality of life after TACE for primary liver cancer [SMD=-0.93, 95%CI (-1.25, -0.60), P<0.001].

3.4.7 Improvement rate of clinical TCM syndromes

13 [13, 21, 25, 26, 31, 32, 36, 40, 41, 44, 45, 47, 53] The outcome index was a study on the improvement rate of clinical TCM syndromes. The results showed that the homogeneity among the studies was good(P=0.19, I2=25%), and a fixed effect model was used. Meta-analysis results showed that compared with conventional western medicine symptomatic treatment, loading oral Chinese medicine has obvious advantages in improving clinical Chinese medicine syndromes after TACE for primary liver cancer [RR=0.73, 95%CI (0.65, 0.82),P<0.001 ]. See Figure 13 for details.

10 studies[18, 20, 21, 22, 23, 25, 29, 32, 40, 45] The outcome index was TCM syndrome score, and the heterogeneity among the studies was large (P<0.001). , I2=88%), using random effects model. The results showed that loading oral Chinese medicine treatment had obvious advantages in improving the quality of life after TACE for primary liver cancer [SMD=1.44, 95%CI (0.95, 1.92), P<0.001].

3.4.8 Short-term curative effect of tumor

Include 15 items [12, 14, 16, 21, 25, 26, 27, 30, 37, 38, 43, 45, 47, 48, 50]The outcome indicator is the study of the short-term efficacy of the tumor, and the results show that the homogeneity among the studies is good (P=0.57, I2=0% ), using a fixed-effects model. Metaanalysis results showed that the short-term curative effect of adding oral Chinese medicine was better than that of conventional western medicine treatment group [RR=0.75, 95%CI (0.66, 0.85), P<0.001].See Figure 14 for details.

3.4.9 1-year survival rate

Figure 13 Forest map for improvement rate of TCM syndrome

Figure 14 Forest map for short-term curative effect of tumor body

Six [27] ,[31] ,[42] ,[43] ,[49] ,[53] outcomes were included It is a study of 1-year survival rate, and the results show that the homogeneity among the studies is good (P=0.62, I2=0%), and a fixed-effect model is used. Meta-analysis results showed that compared with conventional western medicine symptomatic treatment, loading oral Chinese medicine has certain advantages in improving the 1-year survival rate of primary liver cancer after TACE [RR=0.87, 95%CI(0.78, 0.96), P=0.009 ]. See Figure 15 for details.

3.4.10 Liver function and immune function indexes

The results of Meta analysis showed that compared with the symptomatic treatment of western medicine after TACE, loading oral traditional Chinese medicines had certain advantages in improving liver function and immune function indexes, but there was no statistical significance in albumin synthesis function (P=0.14). See Table 2 for details.

3.5 Security Analysis

A total of 8 studies reported safety events. Among them, 4 studies[13, 22, 26, 44] did not show any obvious adverse reactions; Li Bin et al[32] reported 3 cases The patients initially experienced upper abdominal discomfort after taking Jianpi Xiaotan Sanjie Recipe,and the symptoms were relieved after adjusting the medication frequency; in the study of Yu Hui et al [42], 2 patients in the experimental group had skin itching, 3 patients had anorexia, and the control group had anorexia in 2 patients. Among the patients,3 patients had skin itching, 1 had mild stomach pain, and 1 had anorexia. The symptoms improved after symptomatic treatment;Luo Hongxia et al. [49] reported that 8 patients had mild skin pruritus, stomach pain, loss of appetite and other adverse reactions.Symptoms improved after symptomatic treatment; Wang Wenhai et al. [53] reported that a small number of patients in the experimental group and the control group had mild fever, nausea and vomiting,liver pain and other symptoms, and analyzed that the reason may be caused by interventional therapy, symptomatic treatment relieved later.

3.6 Publication bias in the included literature

The short-term efficacy of the tumor was selected as the outcome index as a funnel plot, which can be obtained from Figure 16:

Figure 15 Forest map for 1-year survival rate

Table 2 Metaanalysis results of liver function and immune function indicators

Figure 16 Funnel plot of short-term curative effect of tumor body

3.7 Evidence quality assessment

When using the GRADEprofiler 3.6 software to evaluate the quality of evidence, in terms of risk of bias assessment, since most studies did not report blinding and allocation concealment, it was considered that all indicators were heavily biased; The results of studies that did not find obvious sources of heterogeneity were evaluated as serious inconsistency, and the rest were not serious; in terms of indirectness of indicators, because it was not clear whether there was a direct relationship between each index and the effectiveness of postoperative TACE syndrome, it was not downgraded for the time being; imprecise In terms of sex, because some indicators were included in the study or included too few samples, resulting in a wide confidence interval for the results, they were evaluated as seriously imprecise, and the rest were not serious; except for the outcome indicators that showed obvious publication bias in the funnel plot,they were evaluated as serious publication. Except for bias, the rest were rated as not serious. See Figure 17 for details.

3.8 Sensitivity analysis

Sensitivity analysis was conducted by excluding low-quality literature, and it was found that there was no significant difference between the combined effect size and the original effect size, which proved that the meta-analysis was stable [54] .

4. Discussion

Most primary liver cancers are already in the middle and late stages when they are diagnosed, and they have missed the opportunity of radical surgery. Therefore, hepatic arterial chemoembolization(TACE) plays a prominent role in the treatment of patients with advanced liver cancer, but the vast majority of patients have side effects after TACE. The main manifestation is post-embolization syndrome. From the perspective of traditional Chinese medicine, at this time, the patient has qi stagnation and blood stasis on the basis of the original pathogenesis of deficiency and evil. prescription.Most of the 44 studies included in this study were self-prepared prescriptions. Although the formulations have their own emphasis,the treatment methods include strengthening the spleen and soothing the liver, dispelling tumors and dissipating knots, and many of them have received good results.

Figure 17 Outcome index GRADE evaluation chart

The results of this study show that for patients with postembolization syndrome after TACE for primary liver cancer,adding oral Chinese medicines on the basis of conventional western medicine symptomatic treatment can significantly reduce the incidence of postoperative fever, nausea and vomiting, and liver pain,and shorten the postoperative period. Fever (average shortened by 2.11 days), nausea and vomiting (average shortened by 1.67 days),liver pain (average shortened by 1.90 days), abdominal distention and abdominal pain (average shortened by 1.27 days), constipation(average shortened by 2.30 days), loose stools (average shortened by 2.18 days) days), improved the quality of life of patients (KPS score increased by 0.93 points on average), decreased clinical TCM syndrome scores (with an average decrease of 1.44 points),improved the short-term effective rate and 1-year survival rate of the tumor, and improved liver function to a certain extent. Immune Function. The above results provide a certain reference value for the clinical treatment of postoperative TACE syndrome. On the one hand, loading oral Chinese medicine treatment has a certain effect on the occurrence of postoperative adverse reactions, which is extremely important for patients who are already suffering from the disease. The confidence of patients has a positive impact, thereby greatly improving the quality of life of patients; on the other hand,the results of Meta analysis show that the tumor response rate and 1-year survival rate of patients with primary liver cancer after TACE are significantly higher in On the basis of conventional western medicine treatment, loading oral traditional Chinese medicine also shows certain advantages, which indicates that oral traditional Chinese medicine adjuvant therapy not only has certain curative effect on short-term adverse reactions, but also can further improve the prognosis of patients.

In view of the heterogeneity of some included indicators, this study adopted subgroup analysis and random effects model to reduce the heterogeneity [8] and increase the reliability of the study.Subgroup analysis was conducted according to the characteristics of patients' gender and age, sample size, treatment period and research method as the grouping criteria. The results showed that clinical heterogeneity or methodological heterogeneity mainly came from the treatment period and sample size: the incidence of postoperative fever and the Since the symptoms of low-grade fever were mainly concentrated on the 7th day after the operation, the oral Chinese medicine + conventional western medicine group had more obvious advantages within 7 days of treatment [RR=2.26, 95%CI(1.39, 3.68), P=0.001]; The heterogeneity in the duration of postabdominal distension and abdominal pain, postoperative constipation and the duration of loose stools may be derived from small sample studies. Compared with the subgroup with a sample size of ≥30 cases, the heterogeneity within the subgroup with a sample size of<30 cases was more significant. In addition, due to the large time span of the included studies and the large differences among the selfmade prescriptions of traditional Chinese medicines, there are still some outcome indicators without a clear source of heterogeneity, but for such indicators, random effects models are used, and to a certain extent Heterogeneous effects are eliminated.

The GRADE evidence evaluation results showed that the incidence of fever, abdominal distension and abdominal pain duration, clinical TCM syndrome improvement rate, short-term efficacy of tumor body, and 1-year survival rate were moderate quality indicators; the incidence of nausea and vomiting, the incidence of liver pain, the incidence of abdominal distension and abdominal pain , duration of fever, duration of nausea and vomiting, duration of liver pain,duration of constipation and loose stools, and the improvement rate of KPS score were low-quality indicators; the improvement of liver function and immune function were extremely low-quality indicators. In conclusion, the evaluation quality of this study was classified as low quality. However, in the sensitivity analysis, by eliminating low-quality literature, it was found that there was no significant change in the effect size before and after, indicating that the meta-analysis was stable.

Compared with previous studies, this study included trials conducted in recent years, and analyzed the improvement of each symptom of TACE postoperative syndrome separately; each trial was screened strictly according to the inclusion criteria; the rating of the quality of evidence was added to provide the evaluation of outcome indicators. refer to. However, this study still has the following shortcomings: (1) Since most of the research literature is from Chinese literature, there may be a risk of bias in the study; (2)The intervention measures of the included research groups are quite different, and there are many self-prepared prescriptions, plus the sample size and The large differences in treatment cycles make the literature included in this study heterogeneity; (3) The final report of the included studies is not standardized and inconsistent.

In conclusion, oral traditional Chinese medicine combined with conventional western medicine for symptomatic treatment of TACE syndrome after primary liver cancer is more effective than postoperative western medicine treatment alone. Controlled trials were conducted to further validate the findings.

Description of author's contribution

Li Chen-chen, the first author, is responsible for article topic selection, literature screening, data analysis and draft writing. Zhang Ya-ling, responsible for literature screening, data proofreading,article proofreading, Zheng Yu-ling, corresponding author,responsible for article proofreading, thanks.

Conflict of Interest Statement

All authors declare that no statement of interest exists for this study.