Supplementary file 2_Efficacy and safety of thymosin α1 combined with chemotherapy for gastric cancer: a systematic review and meta-analysis of randomized controlled trials.docx

Regarding inflammatory factors, combination therapy may reduce levels of MMP-2, MMP-9, IL-4, and IL-10, while increasing levels of IFN-γ and TNF-α. Regarding safety, combination therapy was associated with reductions in gastrointestinal reactions (RR = 0.63), myelosuppression (RR = 0.60), abnormal liver function (RR = 0.54), and neurotoxicity (RR = 0.47). However, included RCTs did not systematically report long-term survival outcomes, and their methodological quality was limited; and GRADE indicated that quality of evidence for outcomes ranged from very low to moderate.</p>Conclusion<p>The combination of thymosin α1 with chemotherapy is associated with improved short-term efficacy, enhanced immune function, improved quality of life, and a reduced incidence of adverse reactions in patients with gastric cancer, indicating good potential for clinical application.

However, it remains unclear whether this approach can provide long-term benefits for patients with gastric cancer. Furthermore, given that studies included were all small-sample studies conducted in China and were of limited quality, certainty of evidence is low; these conclusions require further validation through additional high-quality studies.</p>Systematic Review Registration<p>crd.york.ac.uk/PROSPERO/, Identifier CRD420261282679.</p>