AccScience Publishing / EJMO / Online First / DOI: 10.36922/EJMO026140159
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ORIGINAL RESEARCH ARTICLE

Anti-angiogenic and immunoprotective effects of shenmai injection combined with omega-3 fish oil emulsion during neoadjuvant chemotherapy for gastric cancer: A propensity score-matched analysis

Benfeng Xu1 ,  Difeng Zheng2 ,  Xiaoting Fang2 ,  Lin Li1 ,  Fengcong Han1 ,  Haijiang Qiu2*
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1 Department of General Surgery, Shaoxing Central Hospital Ma’an Branch, Shaoxing, Zhejiang, China
2 Department of General Surgery, Shaoxing Central Hospital, Shaoxing, Zhejiang, China
EJMO, 026140159 https://doi.org/10.36922/EJMO026140159
Received: 4 April 2026 | Revised: 12 May 2026 | Accepted: 19 May 2026 | Published online: 5 June 2026
© 2026 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution -Noncommercial 4.0 International License (CC-by the license) ( https://creativecommons.org/licenses/by-nc/4.0/ )
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Abstract

Introduction: Neoadjuvant chemotherapy (NACT) for locally advanced gastric cancer (LAGC) often causes immunosuppression. Shenmai injection (SMI) and omega-3 fish oil (FO) emulsion have immunomodulatory and anti-angiogenic potential, but clinical data on their combined use during NACT are limited.

Objective: This study aims to evaluate the anti-angiogenic and immunoprotective effects of SMI plus FO in LAGC patients receiving NACT using propensity score matching (PSM).

Methods: This retrospective study included LAGC patients (clinical stages II–III) treated with mFOLFOX6-based NACT followed by radical gastrectomy (2018–2024). The treatment group (SMI+FO) received intravenous SMI (50 mL/day) and 10% FO (100 mL/day) for five consecutive days plus standard care; the control group received standard care alone. A 1:1 nearest-neighbor PSM (caliper 0.05) balanced baseline covariates. Tumor angiogenesis was assessed by microvessel density (MVD) using CD34 immunohistochemistry. Immune parameters (CD4+, CD4+/CD8+ ratio, immunoglobulin [Ig]G, IgM) were measured at three time points: admission (T0), preoperative day 1 (T1), and postoperative day 7 (T2).

Results: Of 205 enrolled patients (control n = 120; SMI+FO n = 85), PSM created 60 well-matched pairs. The SMI+FO group showed significantly lower MVD both before and after matching (both p < 0.05). At T1 and T2, the SMI+FO group also demonstrated significantly higher CD4+ counts, CD4+/CD8+ ratios, and serum IgG and IgM levels compared to controls (all p < 0.05).

Conclusion: In this PSM-adjusted cohort of LAGC patients receiving NACT, perioperative SMI plus FO treatment was associated with reduced tumor angiogenesis and reduced chemotherapy-induced immunosuppression. Prospective multicenter trials are needed to confirm these findings and evaluate long-term oncological outcomes.

Keywords
Gastric cancer
Neoadjuvant chemotherapy
Shenmai injection
Omega-3 fish oil emulsion
Microvessel density
Immune function
Propensity score matching
Funding
This work was funded by the Clinical Research Fund Project of Zhejiang Medical Association (2018ZYC-A109). The funder had no role in the study design, data collection, analysis, decision to publish, or preparation of the manuscript.
Conflict of interest
The authors declare no conflict of interest.
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Eurasian Journal of Medicine and Oncology, Electronic ISSN: 2587-196X Print ISSN: 2587-2400, Published by AccScience Publishing
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