Liver cancer: the earlier herbal medicine begins, the greater the benefit — 1,002 real-world records show survival more than doubled

Across the papers in our ongoing "Cancer herbal medicine" series, the research keeps pointing to the same place: adding herbal medicine to standard treatment helps patients live longer. Where the studies introduced so far have mainly explored the theme that "the benefit is greater when it is taken consistently," today's theme is when to start herbal medicine and how long to continue it.

Primary liver cancer (原發性 肝癌, primary liver cancer) is the world's second-leading cause of cancer death, and it is especially common in East Asia, including Korea. Because it usually arises on a background of liver cirrhosis (肝硬變, liver cirrhosis), the prognosis is governed not only by the tumor itself but also by liver function and the patient's overall condition. This is why the 5-year survival rate hovers around 12%.

Standard treatment has kept advancing — surgery and liver transplantation, radiofrequency ablation, transarterial chemoembolization (TACE), and more recently targeted therapy. Herbal medicine has kept pace, with its effectiveness and safety confirmed across many studies. In this column we examine the "effectiveness of herbal medicine" from the angle of timing. When is the best time to start herbal medicine?

What 1,002 real-world medical records revealed

Published in 2023 in the international journal Heliyon, this study analyzed the real-world medical records of 1,002 liver cancer patients treated at Changhai Hospital in Shanghai between 2015 and 2019 — a large real-world study. Patients received herbal medicine based on Jiedu Granule (解毒顆粒, Jiedu Granule) together with supportive care.

The researchers introduced a new measure — the "herbal-treatment ratio," the share of the entire treatment period during which herbal medicine was taken. A higher value means herbal medicine was started closer to disease onset and continued longer. After adjusting for multiple prognostic factors, patients with a higher ratio had about a 76% lower risk of death than those with a lower ratio (relative risk 0.24).

Of course, patients who survive longer naturally have more time to take herbal medicine, which could inflate this effect.^* To strip this away, the researchers used propensity score matching (propensity score matching, PSM) to carefully match the two groups on age, stage, liver function, and tumor characteristics, then compared them again. Even then, median survival in the early-and-long herbal group was 51.5 months, more than double the 21.7 months of the other group. The 5-year survival rate likewise diverged clearly, 45.9% versus 17.0%.

At every stage, those who started earlier lived longer

The study examined liver cancer separately by early (BCLC-A), intermediate (BCLC-B), and advanced (BCLC-C) stage. Comparing median survival after propensity score matching, in the early stage the early-and-long herbal group reached 134.5 months versus 40.8 months; in the intermediate stage, 52.9 versus 23.7 months; and even in the advanced stage, 17.4 versus 10.8 months — ahead at every stage.

Converted to risk of death, this corresponds to reductions of 96% in the early stage, 81% in the intermediate stage, and 51% in the advanced stage. The gap was largest in the early stage, but the benefit was clear even at the most advanced stage — meaning there is no "too late" to start herbal medicine, even for advanced liver cancer.

Starting even a day earlier and continuing even a day longer is more effective

The Jiedu Granule used in this study is composed of 石見穿 (Salvia chinensis), 山慈菇 (Cremastra appendiculata), 雞內金 (Gallus gallus domesticus) and others — a formula with the character of clearing heat and toxins (淸熱解毒, qing re jie du). Yet the key message of this study is not the power of any single formula, but "time."

When herbal medicine is continued steadily from early on, it eases the fatigue, digestive trouble, and decline in liver function left by surgery, embolization, and targeted therapy, helping patients carry standard treatment through to the end. The two-way strategy of "fu zheng qu xie" (扶正祛邪) — keeping the cancer in check while raising the body's own capacity to resist disease — leads to longer survival only when it is started as early as possible and continued as long as possible, not applied briefly.

Don't put off the benefits of herbal medicine

The lesson of this study is clear. Herbal medicine is not "an option to add someday when there is room," but a treatment that helps survival the earlier it is started and the longer it is continued. If you are undergoing treatment for liver cancer or are about to begin, we close by encouraging you to consult thoroughly with a Korean-medicine specialist and steadily continue an herbal medicine prescription you can begin now.

* On the "herbal-treatment ratio" and bias correction A higher share of the treatment period spent taking herbal medicine means it was started earlier and continued longer. However, because patients who survive longer also have more time to take herbal medicine, this measure alone can make the effect look larger than it really is (an illusion that favors those who stayed alive). To reduce this bias, the researchers used propensity score matching to statistically match the two groups on age, stage, liver function, tumor characteristics, and more, and the survival difference persisted afterward. Even so, this is a single-center retrospective observational study, so its results are better understood as one piece of evidence than as proof of causation.