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2 Literature search strategy This review employed a systematic literature search methodology, searching databases including PubMed, Web of Science, Embase, and China National Knowledge Infrastructure (CNKI), with a search period from database inception to November 2024

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Moreover, polysaccharides such as kefiran may stimulate the host immune system via T-cell activation rather than exert direct cytotoxicity on tumor cells (Sharifi et al., 2017)