Abstract
OBJECTIVE: To evaluate the efficacy, safety, and quality of evidence for commercial Chinese polyherbal preparations (CCPPs) in combination with oxaliplatin-based chemotherapy (OX) for gastric cancer (GC). METHODS: We searched six databases for randomized controlled trials (RCTs) comparing CCPPs plus OX to other active treatments for GC. The risk of bias was assessed using a modified version of Cochrane risk of bias tool. A frequentist network meta-analysis using a random-effects model was performed to estimate the relative effectiveness between treatments. We used GRADE to assess the certainty of evidence, to categories the interventions, and to present the findings. RESULTS: One-hundred-and-eighty-nine RCTs involving 15,320 participants that reported 27 CCPPs were identified. Moderate to high certainty evidence showed that Compound Mylabris preparations (Disease Control Rate (DCR): 1.51, 1.13-2.03) is among the most effective CCPPs for improving DCR, while Kangai Injection (objective response rate (ORR): 1.40, 1.28 to 1.77; quality of life (QoL): 1.46, 1.11-1.94), Huachansu preparations (ORR: 1.28, 1.15-1.43), Ya Dan Zi Oil Emulsion Injection (QoL: RR 1.26, 1.06-1.51), Aidi Injection (QoL: 1.30, 1.13-1.50), Lentinan (QoL: 1.27, 1.05-1.54), and Yangzheng Xiaoji Capsules (ORR: 1.36, 1.05-1.77) showed intermediate efficacy for ORR and QoL. Regarding immune function improvement, with moderate to high certainty evidence, Shenmai Injection (CD3(+): 10.03, 1.69 to 18.37; CD4(+): 8.33, 0.64-16.02), Ginseng Polysaccharide Injection (CD3(+): 10.55, 1.89-19.21), Huachansu preparations (CD3(+): 7.42, 2.51-12.34), Kangai Injection (CD3(+): 11.65, 6.81 to 16.50; CD4(+)/CD8(+): 0.25, 0.02-0.47), Lentinan (CD4(+): 9.43, 3.78-15.08), Shenqi Fuzheng Injection (CD4(+): 5.72, 3.68-7.76), and Yangzheng Xiaoji Capsules (CD3(+): 9.32, 0.84-17.80) showed improvements in specific immune parameters. CONCLUSION: No CCPP was optimal for all endpoints, Compound Mylabris showed superior tumor response, and Kangai Injection offered the most favorable risk-benefit profile, providing broad efficacy and statistically significantly reducing AEs. The choice of adjuvant CCPP should be individualized based on specific therapeutic priorities, balancing efficacy and safety. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD42025646173.