{"doi":"10.1093/jnci/djag012","title":"RE: Electroacupuncture for quality of life during adjuvant chemotherapy in gastric cancer: a randomized trial","abstract":null,"journal":"JNCI: Journal of the National Cancer Institute","year":2026,"id":641552,"datarank":0.10397207708399181,"base_score":0.6931471805599453,"endowment":0.6931471805599453,"self_citation_contribution":0.10397207708399181,"citation_network_contribution":0.0,"self_endowment_contribution":0.10397207708399181,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":1,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":null,"is_data_producer":false,"deposit_databanks":null,"is_oa":false,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":null,"fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1668149,"name":"Dan Zang","orcid":null,"position":1,"is_corresponding":false},{"id":252214,"name":"Jun Chen","orcid":"0000-0002-1273-5624","position":2,"is_corresponding":false},{"id":1668148,"name":"Man Sun","orcid":null,"position":0,"is_corresponding":false}],"reference_count":0,"raw_metadata":{"has_enrichment":true,"resolved":true,"title":"RE: Electroacupuncture for quality of life during adjuvant chemotherapy in gastric cancer: a randomized trial","abstract":"We read with great interest the recent randomized trial by Zhu et al.,1 which reports that electroacupuncture administered during adjuvant chemotherapy substantially improved health-related quality of life and unexpectedly prolonged disease-free survival (DFS) in patients with stage II to III gastric cancer. Given the rarity with which supportive care interventions influence survival in solid tumors, the reported DFS benefit is both provocative and deserving of rigorous critique. Several methodological and translational gaps must be addressed before electroacupuncture can be credibly positioned as a survival-modifying intervention. First, the absence of blinding and use of subjective patient-reported outcomes as the primary endpoint introduce substantial risk for expectancy bias. Without a sham or attention control, the observed health-related quality of life gains—and by extension, the DFS signal—may be amplified by contextual effects intrinsic to acupuncture, including therapeutic rituals and patient–clinician interaction.2 The repeated administration of health-related quality of life surveys across time points may further compound bias through anchoring or measurement fatigue.3 Future trials should adopt rigorous sham-controlled designs and triangulate outcomes using immune, behavioral, or neurophysiological correlates to delineate specific vs nonspecific effects. Second, drawing long-term DFS inferences from a short-term electroacupuncture intervention raises concerns about mechanistic durability.4 Without longitudinal immune surveillance or dose-response analyses, it remains speculative whether survival gains reflect durable immune reprogramming or adherence-linked behavioral effects. Future studies should employ structured mediation frameworks to determine whether early symptom relief causally bridges to oncologic benefit. Third, although the authors highlight electroacupuncture’s relevance for symptom clusters and traditional Chinese medicine syndromes, no stratified analysis was performed to identify which symptom trajectories or traditional Chinese medicine diagnostic subtypes were most responsive. This omission overlooks the inherently personalized framework of acupuncture and limits its integration into precision supportive care. Data-driven clustering or responder modeling could elucidate distinct phenotypes of electroacupuncture benefit and enable rational patient selection in future trials.5 Finally, although peripheral myeloid-derived suppressor cells were reduced in the electroacupuncture group, no mechanistic pathway was proposed to explain how this immune modulation might mediate DFS benefit. The reliance on circulating immune markers—without concurrent profiling of the tumor microenvironment, treatment adherence, or immune functional capacity—limits interpretability.6 Clarifying whether these immune shifts are biologically causal or merely epiphenomenal will require future studies to integrate systems-level immune profiling and causal mediation frameworks. In sum, although Zhu et al. suggest that electroacupuncture may influence survival, elevating it from supportive care to a disease-modifying therapy demands robust causal evidence and mechanistic specificity. Nonpharmacologic modalities must meet the same evidentiary thresholds as systemic therapies to inform future guidelines credibly. The funder had no role in the design of the study; the collection, analysis, or interpretation of the data; or the writing of the manuscript and decision to submit it for publication. Man Sun (Conceptualization; Data curation; Visualization; Writing—original draft), Dan Zang (Funding acquisition; Writing—original draft), and Jun Chen (Supervision; Writing—review & editing) This work was supported by the National Natural Science Foundation of China (Grant No. 82203056), awarded to D.Z. None declared. No new data were generated or analyzed for this manuscript.","is_dataset_classified":null,"base_score":0.6931471805599453,"endowment":0.6931471805599453,"datacite_reuse_total":0,"file_count":0,"downloads":0,"views":0,"has_version_chain":false,"is_dataset":false,"is_oa":false,"pmid":"41560399","pmcid":null,"openalex_id":"https://openalex.org/W7125180838","authors":[],"funders":[{"funder_name":"National Natural Science Foundation of China","grant_id":"82203056","title":null}],"total_grants":1,"fwci":null,"citation_percentile":null,"influential_citations":0,"citation_trend":[{"year":2026,"count":1}],"oa_status":"closed","license":"https://academic.oup.com/pages/standard-publication-reuse-rights","oa_locations":[{"url":"https://academic.oup.com/jnci/advance-article-pdf/doi/10.1093/jnci/djag012/66488533/djag012.pdf","host_type":"publisher"},{"url":"https://academic.oup.com/jnci/article-pdf/118/4/757/66488533/djag012.pdf","host_type":"publisher"},{"url":"https://doi.org/10.1093/jnci/djag012","host_type":"journal"},{"url":"https://pubmed.ncbi.nlm.nih.gov/41560399","host_type":"repository"}],"fields_of_study":["Acupuncture Treatment Research Studies","Cancer, Stress, Anesthesia, and Immune Response","Nausea and vomiting management"],"mesh_terms":[],"keywords":["Randomized controlled trial","Quality of life (healthcare)","Chemotherapy","Cancer","Adjuvant chemotherapy","Clinical trial"],"sdg_mappings":[],"linked_datasets":[],"clinical_trials":[],"software_tools":[],"database_accessions":[],"source":"live","citation_network_status":"fetched"},"created_at":"2026-08-07T18:55:51.840040Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}