Toxicity reduction and immune reconstitution with adjuvant traditional Chinese medicine for postoperative ovarian cancer: a systematic review and meta-analysis

Objective To systematically evaluate the efficacy of Traditional Chinese Medicine (TCM) as an adjunctive modality in postoperative ovarian cancer management, specifically focusing on its capacity for toxicity reduction and immune reconstitution. Methods Literature was systematically searched across six databases (China National Knowledge Infrastructure (CNKI), Wanfang Database, VIP Database, SinoMed, PubMed, and the Cochrane Library.) for literature published between January 2018 and June 2025. Randomized controlled trials (RCTs) were included if they compared integrative therapy (TCM plus conventional platinum-based chemotherapy) to conventional therapy alone in postoperative patients with ovarian cancer. The primary endpoint was the incidence of chemotherapy-related adverse events (AEs), while secondary endpoints included immune cell subsets (CD3 + , CD4 + , CD4 + /CD8 + ratio), and Karnofsky Performance Status (KPS). Data were synthesized using random- or fixed-effect models based on heterogeneity ( <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M1"> <mml:msup> <mml:mi>I</mml:mi> <mml:mn>2</mml:mn> </mml:msup> </mml:math> ). Results Twenty-two RCTs ( n = 1719) met inclusion criteria. Adjunctive TCM significantly reduced chemotherapy-related AEs (RR = 0.35, 95% CI 0.27–0.46; <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M2"> <mml:msup> <mml:mi>I</mml:mi> <mml:mn>2</mml:mn> </mml:msup> </mml:math> =0%), and increased T-cell subsets: CD3 + levels improved (MD = 11.74, 95% CI 10.62–12.85; <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M3"> <mml:msup> <mml:mi>I</mml:mi> <mml:mn>2</mml:mn> </mml:msup> </mml:math> =0%) and CD4 + levels increased (MD = 10.04, 95% CI 7.31–12.78; <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M4"> <mml:msup> <mml:mi>I</mml:mi> <mml:mn>2</mml:mn> </mml:msup> </mml:math> =93%), whereas the CD4 + /CD8 + ratio did not show a statistically significant difference (SMD = 3.22, 95% CI 2.41–4.04; <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M5"> <mml:msup> <mml:mi>I</mml:mi> <mml:mn>2</mml:mn> </mml:msup> </mml:math> =90%). KPS scores were higher in the TCM group (MD = 13.06, 95% CI 11.97–14.15; <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M6"> <mml:msup> <mml:mi>I</mml:mi> <mml:mn>2</mml:mn> </mml:msup> </mml:math> =93%). Conclusion The integration of TCM with postoperative chemotherapy provided dual benefit of reducing treatment toxicity and enhancing cellular immune recovery in patients with ovarian cancer. Due to limitations in study quality and heterogeneity, further high-quality RCTs are needed to validate these findings and establish standardized TCM protocols. Systematci review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420251242407 , CRD420251242407.