{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T06:08:45Z","timestamp":1789711725514,"version":"4.0.1"},"reference-count":71,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T00:00:00Z","timestamp":1789689600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To systematically evaluate the efficacy and safety of thymosin \u03b11 combined with chemotherapy in the treatment of gastric cancer.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic search of 8 electronic databases was conducted to identify relevant RCTs. Meta-analysis was performed using Stata 18.0. Meta-regression, subgroup analyses, sensitivity analyses, and publication bias analyses were conducted to further examine results, and reliability of findings was assessed using TSA and GRADE.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      20 RCTs involving 1,704 patients were included. Meta-analysis results showed that, thymosin \u03b11 combined with chemotherapy was associated with higher ORR (RR\u00a0=\u00a01.39), DCR (RR\u00a0=\u00a01.16), and KPS scores (WMD\u00a0=\u00a08.27). Regarding immune function, combination therapy resulted in higher CD3\n                      <jats:sup>+<\/jats:sup>\n                      % (WMD\u00a0=\u00a07.73), CD4\n                      <jats:sup>+<\/jats:sup>\n                      % (WMD\u00a0=\u00a06.87), CD4\n                      <jats:sup>+<\/jats:sup>\n                      \/CD8\n                      <jats:sup>+<\/jats:sup>\n                      (WMD\u00a0=\u00a00.42), and NK cell (WMD\u00a0=\u00a04.73). Regarding tumor markers, combination therapy resulted in lower levels of CEA (WMD = \u22125.48) and CA199 (WMD = \u22129.06). Regarding inflammatory factors, combination therapy may reduce levels of MMP-2, MMP-9, IL-4, and IL-10, while increasing levels of IFN-\u03b3 and TNF-\u03b1. Regarding safety, combination therapy was associated with reductions in gastrointestinal reactions (RR\u00a0=\u00a00.63), myelosuppression (RR\u00a0=\u00a00.60), abnormal liver function (RR\u00a0=\u00a00.54), and neurotoxicity (RR\u00a0=\u00a00.47). 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.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The combination of thymosin \u03b11 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic Review Registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>https:\/\/www.crd.york.ac.uk\/PROSPERO\/<\/jats:ext-link>\n                      , Identifier CRD420261282679.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1884797","type":"journal-article","created":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T05:36:09Z","timestamp":1789709769000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Efficacy and safety of thymosin \u03b11 combined with chemotherapy for gastric cancer: a 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University of Chinese Medicine","place":["Zhengzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruping","family":"Zhao","sequence":"additional","affiliation":[{"name":"Paediatric Hospital, The First Affiliated Hospital of Henan University of Chinese Medicine","place":["Zhengzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xishen","family":"Shan","sequence":"additional","affiliation":[{"name":"Department of Oncology, The First Affiliated Hospital of Henan University of Chinese Medicine","place":["Zhengzhou, China"]},{"name":"Henan University of Chinese Medicine","place":["Zhengzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Liu","sequence":"additional","affiliation":[{"name":"Henan University of Chinese Medicine","place":["Zhengzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuling","family":"Zheng","sequence":"additional","affiliation":[{"name":"Department 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