Gu Zhaohui, Zhang Tian, Chen Xinyue
Clinical Medicine School, Jiangxi University of Traditional Chinese Medicine, Nanchang, China.
Transl Cancer Res. 2025 Aug 31;14(8):5059-5076. doi: 10.21037/tcr-2025-1479. Epub 2025 Aug 27.
Studies have demonstrated the safety and efficacy of traditional Chinese medicine (TCM) injections combined with concurrent chemoradiotherapy (CCRT) in patients with nasopharyngeal carcinoma (NPC). Although studies have examined the impact on immune function, direct comparisons of the effects of various TCM injections on immune function remain limited. Thus, a Bayesian network meta-analysis (NMA) was conducted to assess the beneficial effects of different TCM injections on immune function in patients with NPC during CCRT.
The PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang, Weipu, and China Biology Medicine disc (CBM) databases were searched up to February 2025. The key inclusion criteria incorporated-(I) study subjects: individuals with clinically and pathologically confirmed NPC; (II) the control group received CCRT, and the study group received TCM injections combined with CCRT. The TCM injections of interest were Aidi (AD), Fufangkushen (FFKS), Kushensu (KSS), Shenqifuzheng (SQFZ), Lanxiangxi (LXX), etc.; (III) study type: a randomized controlled trial (RCT); (IV) outcome indicators: CD3, CD4, CD8, CD4/CD8. Two researchers independently screened and extracted the data according to the eligibility criteria. The quality of studies was assessed via the Cochrane Risk of Bias Assessment Tool 2.0 (ROB 2.0). Bayesian NMA was conducted with R version 4.3.3 and Stata 15.1.
This NMA encompassed 11 eligible articles involving 983 patients (496 in the CCRT + TCM injection group and 487 in the CCRT group). Seven TCM injections and four outcome indicators were considered. Due to the inability to implement blinding, all included articles presented a low risk of bias. The results demonstrated that AD injection was the most effective in improving CD3 [surface under the cumulative ranking curve (SUCRA) 96.50%] and CD4 (SUCRA 96.51%). KSS injection was the most effective in improving CD8 (SUCRA 83.51%) and improving the CD4:CD8 ratio (SUCRA 82.80%). Sensitivity analysis indicated stable results.
This NMA demonstrated that TCM injections significantly increased the levels of peripheral blood CD3 and CD4 T-lymphocyte subpopulations during CCRT in patients with NPC. This may reduce the risk of patient infection. Furthermore, TCM injections improved CD8 levels and the CD4:CD8 ratio to some extent. These results suggest enhanced tumor immunosurveillance, potentially leading to improved patient survival. Among the injections, AD and KSS injections exhibited the most significant immune benefits for patients. However, due to the limited number and quality of included articles, further high-quality RCTs are necessary to confirm these results.
研究已证实中药注射剂联合同步放化疗（CCRT）治疗鼻咽癌（NPC）患者的安全性和有效性。尽管已有研究探讨了其对免疫功能的影响，但不同中药注射剂对免疫功能影响的直接比较仍然有限。因此，进行了一项贝叶斯网络荟萃分析（NMA），以评估不同中药注射剂对NPC患者同步放化疗期间免疫功能的有益作用。
检索截至2025年2月的PubMed、Embase、Cochrane图书馆、Web of Science、中国知网（CNKI）、万方、维普和中国生物医学文献数据库（CBM）。关键纳入标准包括：（I）研究对象：临床和病理确诊为NPC的个体；（II）对照组接受CCRT，研究组接受中药注射剂联合CCRT。感兴趣的中药注射剂有艾迪（AD）、复方苦参（FFKS）、苦参素（KSS）、参芪扶正（SQFZ）、榄香烯（LXX）等；（III）研究类型：随机对照试验（RCT）；（IV）结局指标：CD3、CD4、CD8、CD4/CD8。两名研究人员根据纳入标准独立筛选和提取数据。通过Cochrane偏倚风险评估工具2.0（ROB 2.0）评估研究质量。使用R 4.3.3版本和Stata 15.1进行贝叶斯NMA。
该NMA纳入了11篇符合条件的文章，涉及983例患者（CCRT+中药注射剂组496例，CCRT组487例）。考虑了七种中药注射剂和四个结局指标。由于无法实施盲法，所有纳入文章的偏倚风险均较低。结果表明，AD注射液在改善CD3[累积排名曲线下面积（SUCRA）96.50%]和CD4（SUCRA 96.51%）方面最有效。KSS注射液在改善CD8（SUCRA 83.51%）和提高CD4:CD8比值（SUCRA 82.80%）方面最有效。敏感性分析表明结果稳定。
该NMA表明，中药注射剂在NPC患者同步放化疗期间显著提高了外周血CD3和CD4 T淋巴细胞亚群水平。这可能降低患者感染风险。此外，中药注射剂在一定程度上提高了CD8水平和CD4:CD8比值。这些结果表明肿瘤免疫监视增强，可能导致患者生存率提高。在这些注射剂中，AD和KSS注射液对患者的免疫益处最为显著。然而，由于纳入文章的数量和质量有限，需要进一步开展高质量的RCT来证实这些结果。
