Published online Oct 24, 2026. doi: 10.5306/wjco.124301
Revised: July 25, 2026
Accepted: October 8, 2026
Published online: October 24, 2026
Processing time: 133 Days and 16.9 Hours
Systemic treatment for metastatic colorectal cancer (mCRC) is limited by toxicity, drug resistance, and variable patient tolerance. Integrated Chinese-Western medicine is widely used in China, but its association with survival in real-world settings requires careful evaluation.
To evaluate the association between integrated Chinese-Western medicine ther
This retrospective multicenter cohort included patients with mCRC treated from January 1, 2017, to January 1, 2026. The components of the target trial emulation were prespecified. Patients were classified according to the observed duration of oral Chinese herbal medicine use (≥ 3 months vs < 3 months). The primary outcome was overall survival (OS), and the secondary outcome was cancer-specific survival. Stabilized inverse probability weighting was used to balance measured baseline covariates. Weighted Cox models were then used to estimate survival associations. Because the groups were defined by treatment duration after baseline, the estimates were interpreted as associations rather than causal effects.
Of 649 screened patients, 627 were eligible: 490 received oral Chinese herbal medicine for ≥ 3 months, and 137 received it for < 3 months. After weighting, 259 patients in the ≥ 3-month group and 111 in the < 3-month group contributed to the analysis. All reported standardized mean differences were < 0.1. Median OS was 37.5 months in the ≥ 3-month group and 19.5 months in the < 3-month group. The < 3-month group had higher observed hazards of cancer-specific death [hazard ratio (HR) = 6.327, 95%CI: 3.692-10.844] and all-cause death (HR = 14.954, 95%CI: 9.054-24.701; P < 0.001). The unusually large HR should not be interpreted as a causal treatment effect. Its magnitude may have been influenced by the duration-based classification, residual confounding, and model specification.
In this multicenter real-world cohort, oral Chinese herbal medicine use for ≥ 3 months as part of integrated Chinese-Western medicine therapy was associated with longer OS and cancer-specific survival in patients with mCRC. Prospective studies using landmark and time-varying exposure analyses are needed before causal effects or clinical benefits can be established.
Core Tip: In this multicenter retrospective cohort of patients with metastatic colorectal cancer, oral Chinese herbal medicine use for ≥ 3 months was associated with longer overall and cancer-specific survival after inverse probability weighting. The therapeutic principle was standardized, whereas prescriptions were individualized according to syndrome differentiation. Because exposure was defined by observed treatment duration, immortal time bias and residual confounding remain possible. These hypothesis-generating findings require prospective confirmation using landmark and time-varying exposure analyses.