What are the beneficial treatment strategies in maintaining T lymphocyte subsets after cancer surgery? A systematic review and network meta-analysis.

BACKGROUND

Perioperative alterations in T lymphocyte subsets significantly impact tumor recurrence and postoperative recovery; therefore, identifying optimal strategies to maintain these immune parameters is essential for improving cancer surgery outcomes. The immunomodulatory effects of different tumor therapies, especially those on key T cell subsets, still lack systematic comparisons.

OBJECTIVE

This study aims to systematically evaluate the impact of various treatment strategies (including systemic anti-cancer therapy (SACT), nutritional support, anesthesia, analgesia, and other methods) on key immune parameters (CD3+, CD4+, CD8+ cells, CD4+/CD8+ ratio, NK cells) in patients with solid tumors and provide a comparative ranking of their efficacy.

METHODS

Systematic reviews and network meta-analyses were conducted on randomized controlled trials included in the PubMed, Embase and Cochrane CENTRAL databases using the PRISMA guidelines. Pairwise meta-analyses and network meta-analyses were completed using RevMan 5.3 and the gemtc package of R software. The efficacy was ranked by the area under the cumulative ranking curve (SUCRA), and the quality of the studies was evaluated using the Cochrane Risk of Bias Tool 2.0 and the Newnews-Ottawa Scale.

RESULTS

The analysis included 82 RCTs. In maintaining T lymphocyte subsets, immune-enhanced enteral nutrition combined with neoadjuvant chemotherapy (IEN+NACT), targeted therapy (TD), the Enhanced Recovery After Surgery (ERAS) protocol, anesthesia techniques incorporating Transcutaneous Electrical Acupoint Stimulation (TEAS), and analgesia with Dexmedetomidine (DEX) ranked as the most effective strategies, with IEN+NACT showing the greatest improvement in CD4+ counts (SMD 12.33, 95% CI 7.44-17.04). Safety analysis indicated that the risks associated with these top-ranking interventions were acceptable.

CONCLUSION

This network meta-analysis determined that for tumor surgery patients, the perioperative management plan should combine a multimodal strategy of IEN + NACT, ERAS, TD, TEAS and DEX to maintain postoperative T lymphocyte homeostasis and thereby protect immune function.

SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251233455, identifier CRD420251233455.