Traditional Chinese medicine in non-muscle-invasive bladder cancer: a scoping review of syndrome characteristics and critical synthesis of pharmacological and mechanistic evidence

Non-muscle-invasive bladder cancer (NMIBC) is characterized by frequent recurrence and prolonged surveillance. Traditional Chinese medicine (TCM) has been investigated as an adjunct to standard NMIBC management, but its syndrome characteristics and pharmacological evidence remain heterogeneous. This review combined a scoping review of TCM syndrome-related evidence with a critical narrative synthesis of pharmacological and mechanistic studies. The scoping review included 59 sources and identified 155 syndrome-element occurrences. Deficiency (23.9%), dampness (21.3%), heat (20.6%), stasis (16.8%), and toxin (14.8%) were most frequently reported. Among 59 composite-pattern occurrences, Dampness–Heat (30.5%) and Stasis–Toxin (18.6%) predominated. These results reflect literature-level reporting patterns rather than patient-level prevalence. Mechanistic evidence involved tumor-cell survival and death, inflammatory and immune regulation, angiogenesis, invasion, migration, extracellular-matrix remodeling, and tumor-cell reimplantation. However, much of this evidence derives from broader bladder cancer experimental models or predictive analyses, and direct evidence for reducing NMIBC recurrence or progression remains limited. Overall, TCM syndrome characteristics in NMIBC can be described systematically, but mechanistic findings should be interpreted according to their disease context and evidence relevance. Future studies should emphasize standardized syndrome reporting, reproducible intervention characterization, NMIBC-relevant models, and clinically meaningful recurrence-related outcomes.