Objective:

To systematically evaluate the impact of various treatment strategies, including systemic anti-cancer therapy, nutritional support, anesthesia, and analgesia, on key immune parameters in patients with solid tumors and provide a comparative ranking of their efficacy.

Approach:

• Systematic Review and Meta-Analysis: Conducted systematic reviews and network meta-analyses on randomized controlled trials from PubMed, Embase, and Cochrane CENTRAL databases using PRISMA guidelines.
• Data Analysis: Utilized RevMan 5.3 and the gemtc package of R software for pairwise and network meta-analyses, ranking efficacy by the area under the cumulative ranking curve (SUCRA).
• Quality Assessment: Evaluated study quality using the Cochrane Risk of Bias Tool 2.0 and the Newnews-Ottawa Scale.

Key Findings:

• The analysis included 82 RCTs.
• IEN+NACT ranked as the most effective strategy for maintaining T lymphocyte subsets.
• IEN+NACT showed the greatest improvement in CD4+ counts (SMD 12.33, 95% CI 7.44-17.04).
• Other effective strategies included targeted therapy, ERAS protocol, TEAS anesthesia techniques, and DEX analgesia.
• Safety analysis indicated acceptable risks associated with top-ranking interventions.

Interpretation:

The study suggests that a multimodal perioperative management plan is essential for maintaining postoperative T lymphocyte homeostasis.

Limitations:

• Potential biases in study selection and data extraction.
• Variability in treatment protocols across included studies.

Conclusion:

This network meta-analysis determined that for tumor surgery patients, a multimodal strategy of IEN + NACT, ERAS, TD, TEAS, and DEX is essential for maintaining postoperative T lymphocyte homeostasis.

Sources:

• Systematic Review Registration