Immune effect of Traditional Chinese Medicine combined with transcatheter arterial chemoembolization in treatment of liver cancer: a meta-analysis

BACKGROUND: Increasing studies have examined the combination of traditional Chinese medicine (TCM) with Transcatheter arterial chemoembolization (TACE) in treating liver cancer. However, these results were inconsistent in immune function. Therefore, our study aimed to conduct a meta-analysis to evaluate the immune function of TCM combined with TACE in liver cancer patients. METHODS: Seven electronic databases were retrieved from January 1, 2014, to January 6, 2025. The Cochrane Risk of Bias 2.0 tool was used to assess the quality of all the included articles. The primary outcomes were immune-related indicators, which were measured by standard mean difference (SMD) and 95% CI. A random-effects model was used due to the inconsistent units of measurement. Subgroup analysis and sensitivity analysis were used to explore the sources of heterogeneity. Publication bias was systematically assessed using funnel plots and Egger's test. Meta-analysis was performed using the Stata 17.0. RESULTS: Sixty studies involving 5,371 participants were included in this meta-analysis. Our findings indicated that the TCM + TACE group significantly improved immunity compared to the TACE group, including the proportion of CD3+ (SMD = 1.31, 95%CI = 1.08 to 1.53, P < 0.001), CD4+ (SMD = 1.42, 95%CI = 1.18 to 1.66, P < 0.001), CD8+ (SMD=-1.27, 95%CI=-1.63 to -0.92, P < 0.001), and NK cells (SMD = 2.20, 95%CI = 1.66 to 2.74, P < 0.001), as well as the ratio of CD4+/CD8+ (SMD = 1.37, 95%CI = 1.14 to 1.60, P < 0.001). In addition, Combination treatment significantly decreased the level of VEGF (SMD=-2.49, 95%CI=-3.02 to -1.95, P < 0.001) and IL-10 (SMD=-2.38, 95%CI=-3.58 to -1.17, P < 0.001). However, there were no statistical differences in IL-2 and IL-6 levels among treatment groups. CONCLUSIONS: TCM combined with TACE for liver cancer can improve immune function. Additionally, the combination treatment can reduce the VEGF levels associated with inhibiting angiogenesis. Therefore, combining TCM with TACE offers advantages over TACE in treating liver cancer. The protocol has been registered with the International Prospective Register of Systematic Reviews (PROSPERO) (https://www.crd.york.ac.uk/), registration number CRD420251011821.