Impact of materia medica in combination with transarterial chemoembolization on inflammatory markers in patients with hepatocellular carcinoma: A systematic review and meta-analysis.

Objectives: Chinese materia medica (CMM) demonstrates promise in suppressing cancer cell proliferation and metastasis. Cytokines facilitate cellular communication within the tumor microenvironment (TME). This study aimed to examine the influence of integrating CMM with transarterial chemoembolization (TACE) on inflammatory markers and enhancing the TME in hepatocellular carcinoma (HCC) patients.

Methods: Articles published between 2006 and 2023 were comprehensively searched from eight databases. The selected studies met the PICOS criteria and primarily consisted of randomized controlled trials (RCTs) that examined the treatment of primary HCC patients with TACE as a standalone therapy or combined with CMM. The outcome measures included inflammatory markers, objective response rate (ORR), alpha-fetoprotein (AFP) levels, and survival rates.

Results: The meta-analysis included nine RCTs involving 696 HCC patients: 349 in the TACE + CMM group and 347 in the TACE-only group. The TACE + CMM group demonstrated significantly higher levels of IL-2 (P < 0.00001), IL-12 (P < 0.00001), and IFN-γ (P < 0.00001) and significantly lower levels of IL-6 (P = 0.0007), IL-8 (P < 0.00001), TNF-α (P = 0.01), and AFP (P = 0.0002) compared to the TACE-only group. No significant difference in the C-reactive protein level (P = 0.12) was observed between the two groups. The TACE + CMM group showed a higher ORR (P < 0.0001) than the TACE-only group.

Conclusions: Compared to using TACE alone, the integration of CMM with TACE enhanced the modulation of inflammatory markers and the clinical outcomes in patients with HCC.