食管癌临床指南和共识的质量评价  

Quality evaluation of esophageal cancer clinical guidelines and consensus

作　　者：邵丽华 张秋宁 田金徽[4] 杨震 罗宏涛[1,5] 刘锐锋[1,5] 廖亦然 耿一超 王小虎[1,3,4,5] 杨克虎 SHAO Lihua;ZHANG Qiuning;TIAN Jinhui;YANG Zhen;LUO Hongtao;LIU Ruifeng;LIAO Yiran;GENG Yichao;WANG Xiaohu;YANG Kehu(Department of Radiation Oncology,The First Clinical Medical College of Lanzhou University,Lanzhou 730000,P.R.China;Institute of Modern Physics,Chinese Academy of Sciences,Lanzhou 730000,P.R.China;Lanzhou Heavy Ion Hospital,Lanzhou 730000,P.R.China;Basic Medical College of Lanzhou University,Lanzhou 730000,P.R.China;Department of Radiation Oncology,Gansu Provincial Cancer Hospital,Lanzhou 730050,P.R.China)

机构地区：[1]兰州大学第一临床医院放疗科,兰州730000 [2]中国科学院近代物理研究所,兰州730000 [3]兰州重离子医院,兰州730000 [4]兰州大学基础医学院,兰州730000 [5]甘肃省肿瘤医院放疗科,兰州730050

出　　处：《中国循证医学杂志》2020年第5期593-603,共11页Chinese Journal of Evidence-based Medicine

基　　金：国家重点研发计划项目(编号:2016YEC0105706);2017年兰州市人才创新创业项目(编号:2017-RC-23)。

摘　　要：目的评价食管癌临床指南和共识的方法学质量和报告质量。方法计算机检索PubMed、EMbase、Web of Science、CBM、WanFang Data和CNKI数据库,同时补充检索GIN、NICE、NGC和医脉通网站,搜集食管癌相关的临床指南和共识,检索时限均从建库至2018年8月。由2位评价员按照纳入与排除标准独立筛选文献和提取资料后,采用AGREEⅡ和RIGHT工具对纳入指南的质量进行评价。结果共纳入食管癌指南和共识26个。AGREEⅡ各领域平均得分分别为:范围和目的 49.63%、参与人员25.16%、制订严谨性23.42%、清晰性49.25%、应用性16.91%和编辑独立性21.07%;RIGHT评价条目中报告率最高的条目为5(84.62%),其次为1a(80.77%)、1c(65.38%)、13a(65.38%)、4(61.54%),其余条目报告率均在50%以下。亚组分析结果显示:基于循证医学方法制订的指南和共识在AGREEⅡ的6个领域和RIGHT评分平均得分均高于基于专家意见或综述等制订的指南和共识;国外指南和共识在AGREEⅡ的3个领域(制订严谨性、清晰性、编辑独立性)和RIGHT评分平均得分均高于国内指南和共识。结论食管癌临床指南和共识的方法学质量和报告质量均偏低,尤其是我国指南和共识更低,需进一步提高。建议指南制订者参考AGREEⅡ和RIGHT等标准,制订出高质量的指南并推广应用,更好地规范化食管癌的诊疗。Objectives To evaluate the methodological and reporting quality of clinical guidelines and consensus for esophageal cancer. Methods Databases including PubMed, EMbase, Web of Science, CBM, WanFang Data and CNKI were electronically searched and major guideline websites such as GIN, NICE, NGC and Yimaitong were also searched to collect guidelines and consensus for esophageal cancer from inception to August 2018. Two reviewers independently screened the literatures and extracted data according to the inclusion and exclusion criteria and then evaluated the quality of the included guidelines using the AGREE II and RIGHT instruments. Results A total of 26 esophageal cancer guidelines and consensus were included. The mean scores for each domain of AGREE II was 49.63% for scope and purpose, 25.16% for stakeholder involvement, 23.42% for rigor of development, 49.25% for clarity of presentation, 16.91% for applicability, and 21.07% for editorial independence. The item with the highest reporting rate among the RIGHT evaluation items was 5(84.62%), followed by 1 a(80.77%), 1 c(65.38%), 13 a(65.38%), and 4(61.54%),and the remaining items were all reported below 50%. Results of subgroup analysis showed that the guidelines and consensus developed based on the evidence-based medicine method had higher average scores in the six domains of AGREE II and the RIGHT score than the guidelines and consensus developed based on expert opinions or reviews. The foreign guidelines and consensus had higher average scores in the three domains of AGREE II(formulation rigor, clarity,editorial independence) and the RIGHT score than the domestic guidelines. Conclusions The methodological and reporting quality of the guidelines and consensus on esophageal cancer is low, with the guidelines and consensus in China even lower, requiring further improvement. It is suggested that the guideline developers should refer to the standards such as AGREE II and RIGHT to develop high-quality guidelines and promote their application, so as to better guide the st

关 键 词：临床指南 共识 质量评价 AGREEⅡ RIGHT 

分 类 号：R735.1[医药卫生—肿瘤]