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. 2023 Oct 20;102(42):e35000. doi: 10.1097/MD.0000000000035000

Acupuncture or moxibustion adjuvant chemotherapy for advanced non-small cell lung cancer: Systematic review and network meta-analysis

Shiheng Wang a,b, Chaochao Mu c, Fengxia Zhang b, Hanqing Tang a,*, Wanling Ning d
PMCID: PMC10589565  PMID: 37861487

Abstract

Background:

To compare the advantages and disadvantages of different acupuncture and moxibustion methods by network meta-analysis, in order to find out the best acupuncture and moxibustion adjuvant chemotherapy scheme of non-small cell lung cancer (NSCLC).

Methods:

Randomized controlled trials of acupuncture and moxibustion adjuvant chemotherapy in the treatment of NSCLC were searched in PubMed, Cochrane Library, Web of science, EMbase, China National Knowledge Infrastructure, Wanfang, VIP database and SinoMed. The retrieval time was up to December 03, 2022. ROB2 was used to evaluate publication bias, and Stata16 was used for network meta-analysis.

Results:

A total of 14 studies involving 921 patients were included. The results of network Meta-analysis showed that the effect of acupuncture combined with chemotherapy was better than that of chemotherapy (RR = 1.28, 95%CI (1.04,1.58), P < .0001). The effect of acupuncture combined with chemotherapy was better than that of chemotherapy in improving KPS score (MD = 9.01, 95%CI (3.35,14.67), P < .0001). The safety of acupuncture combined with chemotherapy (RR = 0.35, 95%CI (0.15,0.83), P < .0001) was better than that of chemotherapy.

Conclusion:

Acupuncture combined with chemotherapy has the best comprehensive effect.

Keywords: acupuncture, efficacy, network meta-analysis, NSCLC, safety

1. Introduction

Lung cancer is the second most deadly cancer globally.[1] Non-small cell lung cancer (NSCLC) accounts for 85% of all lung cancers.[2] In recent years, the incidence of NSCLC has increased[3] and the 5-year survival rate of intermediate and advanced patients is <5%.[4] Surgery is the first choice for early and middle stage NSCLC. Chemotherapeutic agents are typically administered to patients with intermediate to advanced NSCLC. However, chemotherapy damages normal cells, causing side effects such as immunosuppression, gastrointestinal tract (GI tract) reaction, and bone marrow suppression, which can interfere with chemotherapy.[5] These side effects will affect the process of chemotherapy and the therapeutic effect, and cause pain to patients. Reducing the toxic and side effects of chemotherapy and improving the efficacy and quality of life of patients are very concerned in clinical practice. At present, adjuvant chemotherapy with alternative therapy is one of the commonly used methods in clinical practice.[6]

Acupuncture is a traditional Chinese medicine therapy, which has the advantages of safety, effectiveness, no adverse reactions, no dependence, no addiction, and withdrawal. It is playing an increasingly important role in the adjuvant treatment of cancer. Modern research has proved that acupuncture can increase the pain threshold and activate enkephalin neurons to inhibit pain stimulation and achieve analgesic effects. Acupuncture can enhance the efficacy of chemotherapy, strengthen immune function, reduce adverse reactions, and induce the apoptosis of tumor cells.[7–9]

Currently, many randomized controlled trials (RCTs) on the use of acupuncture for NSCLC have been published, and the results show that acupuncture combine with chemotherapy has excellent efficacy and safety. However, as there are many acupuncture methods, including acupuncture, electroacupuncture, fire needle acupuncture, moxibustion, etc. The existing evidence is a comparison between acupuncture plus chemotherapy and chemotherapy, and it is not known which acupuncture plus chemotherapy is more effective. Different acupuncture and moxibustion procedures have different difficulties and prices. Choosing the best acupuncture and moxibustion method can save costs and reduce the burden of patients, which has clinical value. Network meta-analysis can compare the efficacy of different interventions and rank them to find the best method.[10] Therefore, in this study, we used network meta-analysis to compare the advantages and disadvantages of different acupuncture methods to provide more evidence for clinical treatment of NSCLC.

2. Data and methods

2.1. Inclusion criteria

Study population: patients who met the diagnostic criteria for NSCLC and were staged as stage III/IV.[11–15] Ethnicity, age, gender, and disease duration were not limited. Intervention: Acupuncture or moxibustion combine with chemotherapy (since acupuncture and moxibustion are usually used in combination, acupuncture combine with moxibustion are considered as 1 intervention). Control group: Cisplatin-based chemotherapy (regimens had to be consistent for inclusion in the study to ensure homogeneity). Outcome measure: efficacy (the standard established by WHO)[16]: PR (partial remission), SD (stable disease), and disease progression. The efficacy (ORR) = (PR + SD)/ total number of cases * 100%, adverse reaction, score of life quality (Karnofsky Performance Scale (KPS))[17]; studies reporting at least one outcome measure were eligible for inclusion. Study type: RCT.

2.2. Exclusion criteria

Duplicate literature. Non-RCT (basic test, review, case report, etc). Inconsistent interventions. Inconsistent studied diseases. Incomplete or erroneous data. No mention of outcome measures involved in this study.

2.3. Literature retrieval

We retrieved the appropriate literature from PubMed, EMbase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wanfang, VIP database, and SinoMed. The retrievals were dated from the establishment of the database to December 03, 2022. A combination of subject terms and free terms were used. The retrieval terms included non-small cell lung cancer, non-Small Cell Lung Carcinoma, acupuncture, moxibustion, etc. In addition, gray documents, such as conference papers and dissertations, were also retrieved. The retrieval strategy is described in detail in the Appendix, http://links.lww.com/MD/J695.

2.4. Literature screening and data extraction

Two researchers (Wang S.H. and Zhang F.X.) independently screened the literature according to the established retrieval strategy, imported the retrieved literature into EndNoteX9 software, and eliminated duplicate literature. The remaining unqualified literature were removed after reviewing the titles and abstracts according to the established inclusion and exclusion criteria and the full text was reviewed for further screening. In case of disagreement, a discussion with a third party was performed to determine the final included literature. The data extraction table was designed, including author, year, study population, gender, sample size, intervention, treatment cycle, outcome measure, and others, according to the information needed for the study. When there were inconsistencies in the data extracted by both researchers, they first mutually discussed the inconsistencies to resolve them. A more extensive group discussion was held if they could not resolve the inconsistency.

2.5. Bias risk assessment

Two researchers (Wang S.H. and Ning W.L.) used the Cochrane bias risk assessment tool ROB2 to assess the bias risk of the included literature.[18] The assessment index included 5 items, namely: bias in the randomization process; bias from the intended intervention (the effect of intervention assignment); the bias of missing outcome data; the bias of outcome measurement; and selective reporting bias. The risk of bias in each domain can be classified into 3 levels: “low risk of bias,” “some concerns” and “high risk of bias.” The overall risk of bias is “low risk” if the assessment result of the risk of bias in all domains is “low risk.” If there are some areas with “some concerns” and no areas with “high risk,” the overall risk of bias is “some concerns.” As long as there is a “high risk” in the assessment of the risk of bias in 1 domain, then the overall risk of bias is “high risk.” Two researchers independently evaluated and compared their results. If there was disagreement, a third researcher (Tang H.Q.) was consulted or the decision was discussed. The risk of bias results were plotted.

2.6. Statistical analysis

Network meta-analysis were performed using Stata16 software. Outcome measures were expressed as relative risk (RR) for categorical variables and mean difference (MD) for continuous variables. Both were expressed as effect values and their 95% credibility interval (CI). The evidence network diagram of each index was drawn. If there was a closed loop, inconsistency test was needed to evaluate the consistency between the results of direct comparison and indirect comparison. If there was no closed loop, consistency model could be directly used for analysis. If P > .05, the inconsistency was proved to be good. If P < .05, the report is inconsistent and the results must be treated with caution. Heterogeneity between studies was first assessed. I2 < 50% meant that the heterogeneity among the studies was small, and the fixed-effect model was used for analysis. If I2 ≥ 50%, the random-effect model was adopted and sensitivity analysis and subgroup analysis were conducted to explore the source of heterogeneity. The evidence network of each measure was plotted. The surface under the cumulative ranking (SUCRA) was obtained by ranking the efficacy of each measure. The probability ranking was plotted and SUCRA was expressed as a percentage. The larger the percentage, the more effective the intervention. When it was 0, it indicated that the intervention was absolutely ineffective. When there was a closed loop, inconsistency and convergence tests were performed using the node-splitting method. When the number of outcome measure studies was ≥10, “comparison-adjusted” funnel plots were drawn and the Egger test was used to determine the possibility of publication bias and small sample effects.

3. Results

3.1. Literature retrieval and basic features

The initial retrieval yielded 552 relevant pieces of literature—538 were removed after duplicate checking and reviewing the title, abstract, and full text. Finally, 14 studies were included.[19–32] Figure 1 is the literature screening process.

Figure 1.

Figure 1.

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Literature screening process.

The publication time range of the included studies was 2010 to 2022 and the regions were all in China. The study types were all 2-arm trials, and 921 patients were included (460 in the intervention group and 461 in the control group). Acupuncture and moxibustion methods included acupuncture, electroacupuncture, fire needle acupuncture, moxibustion, wheat-grain moxibustion, and ginger-partitioned moxibustion. The outcome measures included efficacy, KPS, and safety. Table 1 shows the basic characteristics of the literature.

Table 1.

Basic characteristics of literature.

Study Yr Sample size Age Sex (I) Sex (C) Interventions Time Outcomes
I C I C M W M W I C
Gao Y.et al[19] 2018 20 21 - - 13 7 12 9 4 + 7 7 3 wk efficacy,KPS
Pei W.et al[20] 2018 30 30 58.90 ± 8.73 59.63 ± 8.51 17 13 15 15 3 + 7 7 1 wk efficacy
Sha R.et al[21] 2018 58 57 58.13 ± 12.57 57.57 ± 11.44 38 20 41 16 2 + 7 7 4 wk efficacy
Xie B.et al[22] 2017 26 27 57.46 ± 6.33 59.19 ± 5.83 14 12 15 12 6 + 7 7 2 wk safety,KPS
Xuan J.et al[23] 2020 30 30 - - - - - -- 1 + 7 7 3 wk efficacy
Zhang Q.et al[24] 2016 30 30 57.18 ± 7.64 57.26 ± 7.82 16 14 15 15 4 + 7 7 3 wk safety,efficacy
Zhang Y.et al[25] 2016 25 25 - - 15 10 17 8 4 + 7 7 3 wk safety,efficacy
Zhang Y.et al[26] 2014 30 30 61.57 ± 6.53 61.63 ± 6.55 14 16 17 13 3 + 7 7 1 wk safety,efficacy
Gong Y.et al[27] 2020 44 44 56.29 ± 3.71 56.30 ± 3.69 26 18 25 19 6 + 7 7 9 wk KPS,safety
Guo T.et al[28] 2022 50 50 61.58 ± 8.08 61.44 ± 8.13 36 14 33 17 6 + 7 7 3 wk KPS,efficacy
Zhang B.et al[29] 2017 30 30 57.27 ± 5.38 57.32 ± 5.36 20 10 21 9 4 + 7 7 3 wk efficacy,KPS
Zhao C.et al[30] 2017 23 23 61.51 ± 4.90 60.32 ± 5.25 14 9 15 8 1 + 7 7 6 wk efficacy,KPS,safety
Zhao XP.et al[31] 2022 34 34 47.13 ± 4.06 45.47 ± 4.7 21 13 20 14 1 + 4 + 7 7 8 wk efficacy,safety,KPS
Zhu S.et al[32] 2010 30 30 59.07 ± 7.71 59.43 ± 9.44 22 8 19 11 1 + 4 + 7 7 4 wk efficacy,KPS
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1 = acupuncture, 2 = electroacupuncture, 3 = fire needle acupuncture, 4 = moxibustion, 5 = wheat-grain moxibustion, 6 = ginger-partitioned moxibustion, 7 = chemotherapy.

C = control group, I = intervention group, KPS = Karnofsky Performance Scale, M = man, W = woman.

3.2. Quality evaluation of the included literature

Randomization method: 11 studies[19,20,22,23,25–27,29–32] used the randomized number table method. All studies did not describe whether allocation concealment was used. All studies did not describe the use of blinding. Due to the particularity of acupuncture, it is difficult to perform blinding, but patient compliance is good and the results are less likely to be affected by blinding. There were patient withdrawals in 2 studies[19,29]; the possibility that patients were informed of the intervention in advance due to lack of blinding and concealings cannot be excluded, and the possibility of selective reporting cannot be excluded. Data were complete for all studies. 80% of the studies were low risk and 20% were high risk. The overall risk of bias was relatively low. Figure 2 is the bias risk assessment chart of the included studies.

Figure 2.

Figure 2.

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Bias risk assessment.

3.3. Network meta-analysis

3.3.1. Evidence network diagrams.

The results: efficacy: 12 studies were included. The evidence network was centered on chemotherapy and involved 6 acupuncture methods. There was no closed loop between the studies. The consistency test results were good, and the heterogeneity was small (P > .05, I2 = 0%). KPS: 7 studies were included. The evidence network was centered on chemotherapy and involved 5 acupuncture methods. There was no closed loop between the studies, and the consistency test results were good, but there was heterogeneity (P < .05, I2 = 58%). Safety: 7 studies were included. The evidence network was centered on chemotherapy and involved 5 acupuncture methods. There was no closed loop between the studies. The consistency test results were good, and there was heterogeneity (P < .05, I2 = 55%). Figures 3–5 are evidence network diagrams.

Figure 3.

Figure 3.

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Network evidence diagram (efficacy).

Figure 5.

Figure 5.

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Network evidence diagram (safety).

Figure 4.

Figure 4.

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Network evidence diagram (KPS). KPS = Karnofsky Performance Scale.

3.3.2. Network meta-analysis results.

  • (1)

    Efficacy: 42 comparative results of different acupuncture were formed. The results showed that, compared with chemotherapy, acupuncture + chemotherapy (RR = 1.28, 95%CI (1.04,1.58), P < .0001), fire needling + chemotherapy (RR = 1.28, 95%CI (1.03,1.59), P < .0001), moxibustion + chemotherapy (RR = 1.27, 95%CI (1.08,1.51), P < .0001), and acupuncture + moxibustion + chemotherapy (RR = 1.25, 95%CI (1.06,1.48), P < .0001) had a better effect. The ranking of SUCRA was acupuncture + chemotherapy > fire needling + chemotherapy > moxibustion + chemotherapy > acupuncture + moxibustion + chemotherapy > electroacupuncture + chemotherapy > ginger-separated moxibustion + chemotherapy > chemotherapy.

  • (2)

    KPS: 30 comparative results of different acupuncture-moxibustion were formed. The results showed that compared with chemotherapy, acupuncture + chemotherapy (MD = 9.01, 95%CI (3.35,14.67), P < .0001), moxibustion + chemotherapy (MD = 5.78, 95%CI (2.85,8.72), P < .0001), wheal-grain moxibustion + chemotherapy (MD = 7.34, 95%CI (3.45,11.23), P < .0001), ginger-separated moxibustion + chemotherapy (MD = 2.56, 95%CI (0.53,4.59), P < .0001), acupuncture + moxibustion + chemotherapy (MD = 3.51, 95%CI (0.94,6.08), P < .0001) had better effect. Compared with ginger-separated moxibustion + chemotherapy, acupuncture + chemotherapy (MD = 6.45, 95%CI (0.44,12.46), P < .0001) and wheat-grain moxibustion + chemotherapy (MD = 4.78, 95%CI (0.39,9.17), P < .0001) had better effect. The ranking of SUCRA was acupuncture + chemotherapy > wheat-grain moxibustion + chemotherapy > moxibustion + chemotherapy > acupuncture + moxibustion + chemotherapy > ginger-separated moxibustion + chemotherapy > chemotherapy. Acupuncture combined with chemotherapy has the best effect on improving the quality of life.

  • (3)

    Safety: Forty-two comparative results of different acupuncture were formed. The results showed that compared with chemotherapy, acupuncture + chemotherapy had better effect (RR = 0.35, 95%CI (0.15,0.83), P < .0001). The ranking of SUCRA was acupuncture + chemotherapy = acupuncture + moxibustion + chemotherapy > ginger-separated moxibustion + chemotherapy > fire needling + chemotherapy > moxibustion + chemotherapy > chemotherapy > wheat-grain moxibustion + chemotherapy. Acupuncture plus chemotherapy and acupuncture plus chemotherapy had the best safety. Acupuncture combined with chemotherapy has the best comprehensive effect. The league table is in the Appendix, http://links.lww.com/MD/J695. Figure 6 is the combined effect. Table 2 is the SUCRA values and ranking.

Figure 6.

Figure 6.

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Comparison of comprehensive effect.

Table 2.

SUCRA value and ranking through network meta-analysis.

Intervention Efficacy KPS Safety
SUCRA ranking SUCRA ranking SUCRA Ranking
1 + 7 65.5 1 89.1 1 82.1 1
2 + 7 47.0 5 - - - -
3 + 7 64.8 2 - - 53.7 4
4 + 7 64.6 3 65.0 3 42.9 5
5 + 7 - - 79.8 2 8.4 7
6 + 7 46.6 6 26.6 5 62.9 3
1 + 4 + 7 59.7 4 39.3 4 82.1 1
7 2.0 7 0.2 6 17.8 6
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KPS = Karnofsky Performance Scale, SUCRA = the surface under the cumulative ranking.

3.3.3. Publication bias.

A comparative-adjusted funnel plot for the outcome measures with > 10 included studies was plotted. The results of the comparative-adjusted funnel plot showed an uneven distribution of study points. Results of the Egger test: efficacy: P = .001 The above results suggest likelihood of publication bias. Figure 7 is the comparison-corrected funnel plot.

Figure 7.

Figure 7.

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Comparison-corrected funnel plot.

3.4. Sensitivity analysis

A sensitivity analysis of outcome measures with heterogeneity was performed, and the results were found to be stable; the figure of the sensitivity analysis is provided in the Appendix, http://links.lww.com/MD/J695.

4. Discussion

NSCLC is a common malignant tumor.[33] In recent years, the incidence and mortality rates have increased to varying degrees. Many patients have developed into the advanced stage by the time they are diagnosed and cannot achieve the desired outcome because the disease is relatively insidious.[34] Surgery, radiotherapy, and chemotherapy are the main methods of treatment. However, they are prone to multiple adverse reactions, there is a severe impact on the life quality of patients, and the 5-year survival rate remains <15%.[35] Although new targeted agents have achieved good clinical efficacy in recent years, they are expensive. Therefore, the search for more therapeutic methods and multidisciplinary integrated treatment has become the trend in the clinical treatment of tumors. Acupuncture and moxibustion are widely used in combined treatment for lung cancer.

A total of 14 studies were included. Network meta-analysis results: efficacy: Compared with chemotherapy, a combined treatment of acupuncture and chemotherapy were more effective. The results of SUCRA ranking showed that acupuncture combined with chemotherapy might be the most effective intervention (SUCRA = 65.5%).In terms of improve life quality, compared with chemotherapy, acupuncture combine with chemotherapy are better. The results of SUCRA ranking showed that acupuncture combined with chemotherapy had the best effect on improving the quality of life (SUCRA = 89.1%).In terms of safety: Compared with chemotherapy, acupuncture combine with chemotherapy are better. The results of SUCRA ranking showed that acupuncture combine with chemotherapy and acupuncture combine with moxibustion and chemotherapy may have the best safety (SUCRA = 82.1%). Sensitivity analysis showed that the results were stable. Based on the results of this study, it was found that among the acupuncture methods, acupuncture was the best adjuvant method for chemotherapy. Studies have shown that the effect of acupuncture is mainly to enhance the effect of chemotherapy and reduce the toxic side effects of chemotherapy, so as to improve the quality of life. Firstly, acupuncture can improve human immune function and inhibit tumor growth.[36] Acupuncture can enhance the content of immune cells (CD3 + T, CD4 + T), reduce CD8 + T content, increase CD4+/CD8 + ratio, and enhance the killing activity of NK cells. Many acupoints on the human body, such as Zusanli (ST36), Feishu (BL13), Qihai (CV5), etc, have the effects of regulating immune function and anti-tumor. Second, acupuncture can reduce the side effects of chemoradiotherapy and improve the quality of life. Acupuncture and moxibustion can effectively improve the gastric mucosal function damage caused by chemotherapy drugs and protect the gastric mucosa. At the same time, it can reduce nausea and vomiting caused by chemotherapy by inhibiting gastric retrograde peristaltic contraction and sensitivity to chemical drugs. Acupuncture can improve the expression and activity of serum colony-stimulating factor, thereby promoting the secretion and proliferation of bone marrow cells and reducing the incidence of bone marrow suppression caused by radiotherapy and chemotherapy drugs.[37] Relieve cancer pain. Studies have shown that acupuncture at acupoints can stimulate the secretion of β-enikacin and interleukin-2 in the human body, which can effectively relieve pain with rapid action and no side effects.[38] Acupoints in the human body, such as Neiguan (ST36), Guanyuan (RN04), Weishu (BL21), etc, have such effects and can improve the survival rate of patients.[39] At the same time, the thermal effect produced by moxibustion can regulate the immune system, adjust the balance of T cell subsets, maintain a relatively stable environment in the human body, have a good regulatory effect on internal environmental disorders caused by tumors, and reduce adverse reactions caused by internal environmental disorders caused by chemotherapy.[40] Compared with electroacupuncture and fire needling, acupuncture is more convenient, safer and cheaper, which is a good choice for doctors and patients.

A published meta-analysis[41] compared the efficacy of acupuncture combined with painkillers in the treatment of lung cancer pain. The results showed that acupuncture combined with pain reliever was superior to pain reliever alone in the treatment of lung cancer pain and analgesia [SMD = 0.68, 95%CI(0.07,1.28), P = .03 < 0.05]. In terms of adverse reactions, the results showed that acupuncture therapy could reduce adverse reactions [OR = 0.43, 95%CI(0.22,0.82), P = .01 < 0.05]. This is consistent with the results of this study. However, due to the differences in the included literature, lung cancer was included, not only non-small cell lung cancer, so more clinical evidence is needed to further verify the effectiveness and safety of acupuncture in the treatment of non-small cell lung cancer.

Advantages of this study: At present, there is no evidence of differences in the effectiveness and safety of different acupuncture treatments for non-small cell lung cancer. For the first time, we conducted a mesh meta-analysis of acupuncture in the treatment of non-small cell lung cancer to compare the efficacy and safety differences of different acupuncture treatments. In addition, we used strict inclusion and exclusion criteria, including only full-text randomized controlled trials.

Limitations of this study: The included studies were all from China, with some bias. The quality of the included studies was low. Most studies did not report randomized methods, allocation concealment, and blinding method settings, which might reduce the reliability of the results and increase the risk of bias. There was a lack of direct comparative studies of different acupuncture methods. The small number of directly comparable studies reduces the reliability of the results of the meta-analysis. The wide 95%CIs for effect sizes of many study results were not statistically significant and may affect statistical efficiency. Lack of endpoint adjudication indicators such as mortality and survival rates are highly relevant to patients and have high practical value.

Suggestions for future studies: Study reports should be carried out strictly in accordance with international CONSORT standards to reduce the risk of bias.[42] Attempt to conduct studies on the efficacy characteristics and dominant population of real-world-based acupuncture methods to guide precise clinical treatment and subsequent research directions. Conduct more RCTs with direct comparison of different acupuncture methods and focus on key outcome measures such as survival rate and long-term disability rate. A questionnaire survey was conducted among doctors and patients to investigate the effect and popularity of different acupuncture methods to find more evidence.

5. Conclusion

The results of this study show that the combination of acupuncture, moxibustion, and other treatments is effective and safe in treating NSCLC. However, the efficacy of different acupuncture methods in each outcome measure varies. Overall, acupuncture combine with chemotherapy may be the optimal intervention. As the methodological quality of the included studies is on the low side, the potential for bias is high. The conclusion remains to be verified by high-quality studies.

Acknowledgments

We would like to acknowledge the hard and dedicated work of all the staff that implemented the intervention and evaluation components of the study.

Author contributions

Conceptualization: Shiheng Wang.

Data curation: Shiheng Wang, Fengxia Zhang, Wanling Ning.

Formal analysis: Shiheng Wang, Fengxia Zhang, Wanling Ning.

Funding acquisition: Hanqing Tang.

Writing – original draft: Shiheng Wang.

Writing – review & editing: Shiheng Wang, Chaochao Mu, Hanqing Tang, Wanling Ning.

Supplementary Material

medi-102-e35000-s001.docx (31.4KB, docx)

Abbreviations:

CI
credibility interval
KPS
Karnofsky Performance Scale
MD
mean difference
NSCLC
non-small cell lung cancer
PR
partial remission
RCT
randomized controlled trial
RR
relative risk
SD
stable disease
SUCRA
the surface under the cumulative ranking

SW and CM contributed equally to this work.

Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.

PROSPERO Registration No.: CRD42023401520.

National Natural Science Foundation of China (No.81360579).

This study is a literature study and does not involve ethics.

Supplemental Digital Content is available for this article.

The authors have no conflicts of interest to disclose.

How to cite this article: Wang S, Mu C, Zhang F, Tang H, Ning W. Acupuncture or moxibustion adjuvant chemotherapy for advanced non-small cell lung cancer: Systematic review and network meta-analysis. Medicine 2023;102:42(e35000).

Contributor Information

Shiheng Wang, Email: wangshihuanwsh@21cn.com.

Chaochao Mu, Email: muchao0chao@21cn.com.

Fengxia Zhang, Email: zhangfengxiazfx9@21cn.co.

Wanling Ning, Email: ningwanlingnwl0@outlook.com.

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