Abstract
Dear Editor,
We read with great interest the systematic review and meta-analysis by Liu et al, 1 published in Integrative Cancer Therapies, which included 64 randomized controlled trials (RCTs) and suggested that acupuncture may improve certain cytokine levels and immune cell indicators. We commend the authors for their contribution to this field but would like to offer several comments for consideration.
First, the review included a wide variety of outcome measures without standardization. Except for interferon-γ, the majority of pooled outcomes showed substantial heterogeneity. The included studies covered different cancer types and treatment stages but lacked subgroup analyses, and many were small, single-center trials. These limitations may weaken the reliability of the findings.2,3
Second, most trials lacked blinding. The absence of blinding can significantly influence treatment effect estimates. 4 We recommend that future meta-analyses prioritize the inclusion of studies implementing blinding to improve credibility.
Finally, the evidence base relied predominantly on studies from China, which may lead to geographic and language biases. Future study should aim to incorporate research from diverse regions and languages to reduce bias and improve the generalizability of conclusions.
In conclusion, we acknowledge the significant efforts and contributions of Liu et al in advancing scholarly understanding of acupuncture’s immunomodulatory effects in oncology and consider this study to be a valuable reference source for subsequent research. We hope our suggestions may help enhance the accuracy and generalizability of future studies.
