Abstract
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.